Forms
Download and fill out these forms:

Patient Information Form...	PSSA Financial Policy...
Consent for Treatment...	Notice of Privacy Practices...
Benefits Verification Form...
Register for Stepping Stones 1. Print out and complete the registration form. Stepping Stones Registration Form... 2. Calculate the total fee: $30 per child in each age group, 6-9 10-13 14-17. 3. Bring or Mail the completed form and payment (CASH OR MONEY ORDER ONLY) in the correct amount to:       Stepping Stones       1100-01 S. Ponce de Leon Blvd       St. Augustine, FL 32084   About Stepping Stones...

Please return completed forms to us at your earliest convenience. You may fax to (904) 829-9768 or mail to

Psychological Services of St. Augustine
1100-1 South Ponce de Leon Blvd.
St. Augustine, FL 32084

You may also choose to hand-deliver forms to our office.

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Forms are provided in PDF format. They require the Adobe Acrobat Reader.

If you have the Acrobat Reader version 6 or higher, you can fill in the form by typing into the fields provided, then print the completed form, and fax/mail/hand-deliver it.

With older versions of Acrobat Reader or alternative PDF reader software, you can print the blank form, then fill it out normally and fax/mail/hand-deliver it.

If you do not have the Acrobat Reader, it is available as a free download
from the Adobe Web Site...

Psychological Services of St. Augustine, Inc.

Main Office: 1100-1 South Ponce de Leon Boulevard, St. Augustine, Florida 32084
Phone (904) 824-7733 Fax (904) 829-9768

Southlake Office: 300 Kingsley Lake Dr, Suite 403 St Augustine, FL 32092

pssa@pssacare.com