Client Forms
Print, Complete, Sign, and Bring to Your First Session:
INFORMED CONSENT: My Informed Consent Form details succinct information about confidentiality. If you have any questions about confidentiality, please discuss them with me when we meet.
OFFICE POLICIES FORM: My Office Policies Form explains my office procedures and agreement for psychotherapy services. This includes important information about your confidentiality. If you have questions after reading this form, please bring them up when we meet.
SOCIAL MEDIA POLICY: My Social Media Policy explains my policies and procedures as they relate to our potential interactions on the Internet. Please let me know if you have questions or concerns about these policies.
HIPAA: I am required by law to provide you with a copy of the HIPAA Notice of Privacy Practices so you can understand your rights and protections related to the use and disclosure of your identifiable health care information.
During our Work Together:
AUTHORIZATION TO RELEASE INFORMATION:
There may be times when you and I agree it would be helpful for me to speak with another person to coordinate your care. With the exception of the situations outlined in the HIPAA Notice of Privacy Practices, I cannot do this without your written consent. Usually, we will speak about this in person and you will sign the form in my office. However, if you’re unable to meet with me, you may complete my Authorization to Release Information Form and return it to me.
INFORMED CONSENT: My Informed Consent Form details succinct information about confidentiality. If you have any questions about confidentiality, please discuss them with me when we meet.
OFFICE POLICIES FORM: My Office Policies Form explains my office procedures and agreement for psychotherapy services. This includes important information about your confidentiality. If you have questions after reading this form, please bring them up when we meet.
SOCIAL MEDIA POLICY: My Social Media Policy explains my policies and procedures as they relate to our potential interactions on the Internet. Please let me know if you have questions or concerns about these policies.
HIPAA: I am required by law to provide you with a copy of the HIPAA Notice of Privacy Practices so you can understand your rights and protections related to the use and disclosure of your identifiable health care information.
During our Work Together:
AUTHORIZATION TO RELEASE INFORMATION:
There may be times when you and I agree it would be helpful for me to speak with another person to coordinate your care. With the exception of the situations outlined in the HIPAA Notice of Privacy Practices, I cannot do this without your written consent. Usually, we will speak about this in person and you will sign the form in my office. However, if you’re unable to meet with me, you may complete my Authorization to Release Information Form and return it to me.