Please complete these online forms prior to your first appointment. If you are the responsible party, please complete these forms yourself. If you are not the responsible party, we must obtain written consent of the legal guardian or another authorized legal representative prior to rendering services in the event the client is a minor child, an adult who is legally incompetent, or an adult incapable of giving informed consent.
Cathy’s Clients |
Jennifer’s Clients |
| Informed Consent Fill out and submit the form online prior to your first appointment. |
Informed Consent Fill out and submit the form online prior to your first appointment. |
| Or fill out a printable version of this form prior to your first appointment | Or fill out a printable version of this form prior to your first appointment |
| HIPPA Notice of Privacy Review and keep for your records |
HIPPA Notice of Privacy Review and keep for your records |
| HIPPA Acknowledgement Fill out and submit the form online prior to your first appointment. |
HIPPA Acknowledgement Fill out and submit the form online prior to your first appointment. |
| Or fill out a printable version of this form prior to your first appointment | Or fill out a printable version of this form prior to your first appointment |
| Billing Agreement Fill out and submit the form online prior to your first appointment. |
Billing Agreement Fill out and submit the form online prior to your first appointment. |
| Or fill out a printable version of this form prior to your first appointment | Or fill out a printable version of this form prior to your first appointment
Print and fill out this form if you ALSO have Supplemental Insurance Information |
| New Client Questionnaire Fill out and submit the form online prior to your first appointment. |
Fill out and submit the form online prior to your first appointment. |
| Or fill out a printable version of this form prior to your first appointment | Or fill out a printable version of this form prior to your first appointment |
| Telehealth Informed Consent Fill out and submit the form online prior to your first appointment. |
Telehealth Informed Consent Fill out and submit the form online prior to your first appointment. |
| Or fill out a printable version of this form prior to your first appointment | Or fill out a printable version of this form prior to your first appointment |
| Release of Information Only fill out this form if your information may be used or disclosed in connection with treatment or healthcare operations. If so, fill out and submit the form online. |
Release of Information Only fill out this form if your information may be used or disclosed in connection with treatment or healthcare operations. If so, fill out and submit the form online. |
| Or fill out a printable version of this form. | Or fill out a printable version of this form. |
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