Forms

Please complete these forms prior to your first visit.  My email account does meet HIPAA compliant security standards for transferring protected health information.  However, if you send me these completed forms from your email account, and it is not HIPAA compliant (and most are not), then you risk having your information seen by others.   To protect against this you may want to encrypt the completed forms before sending them to me, then separately, perhaps with a text, you can provide me the password to open your documents. You can also send them to me by US mail.  If you choose to  bring the completed forms with you on your first visit, you should understand that I will have to take the time during our fist session to read the forms.  I cannot begin our first session without looking over this information.  Alternatively, if I get the forms from you 24 hours in advance, I will read them prior to our appointment.   After you send me the forms, I will print them for you to sign in my office. 

Client Demographics, RS (pdf)

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Patient Health Questionnaire, RS (pdf)

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Insurance Billing Information, RS (pdf)

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Release of Information, To & From, RS (pdf)

Download

HIPAA Notice of Privacy, RS (pdf)

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