Please complete the following forms and bring the "office copy" versions with you to your first appointment. All "patient copy" versions of the forms are for your records only. If you have any questions about the forms, please do not hesitate to call or email. If you have any difficulty downloading these forms, they can be emailed to you at your request. These forms will be reviewed at the beginning of your initial appointment.

 

​New Patient Forms: Obtains information about your medical history and background information.

 

Patient Financial Responsibility Agreement: Authorized credit card form to keep on file necesssary to begin services.

 

Notice of Privacy Practices: For your records, explains your rights and how your protected health information (PHI) will be used.

 

Outpatient Services Contract: Contains information about the scope of treatment, office policies, fees, and consent for treatment.

 

Authorization for Release of Protected Health Information: Authorizes release of protected health information (PHI) to other providers, professionals, and/or family members for coordination of care and to aid in your treatment.

 

Expert Witness Testimony Retainer Agreement for Services: Agreement and contract for retaining expert witness testimony services.

 

Teletherapy Services Agreement: Agreement and consent for teletherapy or "telehealth" services to be furnished via a HIPAA compliant electronic platform.

 

Credit Card Authorization Form: This form collects and authorizes credit card charges to be made for services rendered and for other fees that arise throughout the course of treatment.

 

Parking Instructions: Map providing location of free 2-hour visitor parking. My office will not validate parking.