Forms

Please print, read, sign, and bring to your first session

Forms to be read and filled out before our appointment:

The Office Policies & Informed Consent is required by law when we begin our professional relationship.

The Client Information form provides me with basic information about you and will assist me in attending
to your needs. I need each person who will be participating in treatment to fill out this form.

The Treatment, Payment, and Health Care Operations (TPO) Consent form is standard for any health
care provider and is required by HIPPA law. It also has a place for you to acknowledge receiving the
HIPPA Leaflet.

Download here.

General Office Policies

Please review my policies on appointments, cancellations, payments and insurance. Print and read this page before our first session. Please bring questions to your first session.

Download here.

 

HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

Download here.