Please download and print the following forms before your ﬁrst appointment:
- Client History Form
- Please print and complete the Client History Form before our ﬁrst meeting together and bring it to your ﬁrst session.
- Consent for Services Form
- Please print the Consent for Services Form, read it carefully, sign it, and bring it to your ﬁrst appointment. You should also keep a copy of this form for your records.
- HIPAA Notice
- The Health Insurance Portability and Accountability Act (HIPAA) is a federal mandate for privacy issues that cover certain health services. Before your ﬁrst appointment, please read the HIPAA Notice carefully and print out a copy for your records.
- Electronic Payment Authorization Form
- To save time and eliminate the hassle of weekly payment, I strongly encourage clients to complete the Electronic Payment Authorization Form. This form allows me to deduct the session fee (including fees for no-shows and late cancellations) from the credit card or debit card designated on this form. Please print out this form, complete it, and bring it to your initial appointment. This information will be stored securely in your clinical ﬁle and may be updated upon request at any time.
Note: If you cannot open the forms then you may have a Pop-Up blocker installed. Try holding down the “CTRL”, “ALT” or “Shift” key when clicking on the form link. That should allow the window to open.