Forms

FOR ADULT CLIENTS

Please READ these forms before your appointment:

Notice of Privacy Practices

Policy and Information for Adult Services

Client Rights and Responsiblilities

Please PRINT, FILL OUT and BRING IN these completed forms to your appointment:

Client Information Summary

Acknowledgement of Receipt of Privacy Policy

Policy and Information for Services for Adults

Authorization for Insurance

Informed Consent for Adults

Authorization for Notification of Breach

FOR PARENTS or GUARDIANS OF MINOR CLIENTS

Please READ these forms before your appointment:

Notice of Privacy Practices

Policy and Information for Services for Minors

Client Rights and Responsiblilities

Please PRINT, FILL OUT and BRING IN these completed forms to your appointment:

Client Information Summary

Acknowledgement of Receipt of Privacy Policy

Informed Consent for Minors

Behavior Symptom Checklist

Authorization for Insurance

Authorization for Notification of Breach

Personal History for Child/Adolescent Clients