If you're a new client, please review "Informed Consent for Treatment" and "HIPAA Notice of Policies and Procedures"- these are for you to keep for your records. Please complete the "Client Information", "Background Information", "Consent Acknowledgment for Treatment", "Client Acknowledgment of HIPAA", and "Payment Authorization" forms and submit them for your initial consultation appointment. These forms will go into your treatment file of record.
- Client Information
- Background Information
- Informed Consent for Treatment
- Consent Acknowledgment for Treatment
- HIPAA Notice of Policies and Procedures
- Client Acknowledgment of HIPAA Notice
- Payment Authorization Form
If you would like me to consult with and coordinate care with another provider (e.g. your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information. Please use a separate form for each person with whom you would like me to consult and coordinate care.
Note: To download Adobe Acrobat Reader for free, click here .