Office Policies and Intake Forms

 

Prior to our first session, read my policies then download and complete these forms and bring them in with you:

 

1. Intake Forms

Disclosure of Office Policies; General Information, Family of Origin Information, Medical/Psychological History

 

2. HIPAA Notice of Privacy Practices 

Please read and sign the form.

 

3. Health Insurance Claim Form (HICFA 1500 - 12/90)

Please complete the "Patient and Insured" section on Page 1 only.

 

 

These forms are provided in Adobe Reader (PDF) format. To view and print them, you will need the Free Adobe Reader, available here.

 

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