Privacy, Policies, & Forms
For your convenience, I have provided some of my forms electronically. If you have any problems downloading or printing the form, please let me know. I can also mail/email forms to you before your first appointment for your convenience.
All New Clients
Disclosure Policy Statement and HIPPA Privacy Notice. I recommend reading the Disclosure Policy Statement and HIPAA Privacy Notice prior to the first session. It is also helpful information for teens. Please print and sign the signature page (the last page) and bring it to the first session.
Insurance Authorization Form - If you would like me to bill your insurance.
All New Clients
Disclosure Policy Statement and HIPPA Privacy Notice. I recommend reading the Disclosure Policy Statement and HIPAA Privacy Notice prior to the first session. It is also helpful information for teens. Please print and sign the signature page (the last page) and bring it to the first session.
Insurance Authorization Form - If you would like me to bill your insurance.
Please select the appropriate Intake Paperwork for you or your family, print and complete the forms. Please bring the complete paperwork with you to the first appointment.
Adult Registration
Teen Registration - To be completed by a parent or guardian. Please allow 20 minutes to complete this form.
Child Registration - To be completed by a parent or guardian. Please allow 20 minutes to complete this form.
About Me - Optional for Teens.
Additional Forms - If needed for communication with teachers, doctors, psychiatrist, or other specialists.
Authorization to Release Information (for Adults)
Authorization to Release Information (for minors)
Adult Registration
Teen Registration - To be completed by a parent or guardian. Please allow 20 minutes to complete this form.
Child Registration - To be completed by a parent or guardian. Please allow 20 minutes to complete this form.
About Me - Optional for Teens.
Additional Forms - If needed for communication with teachers, doctors, psychiatrist, or other specialists.
Authorization to Release Information (for Adults)
Authorization to Release Information (for minors)
|
|
|
| ||||||||||