Forms

Below you will find all the forms you need to fill out before your first visit, with a brief description of why each form is important. While I know that paperwork can be daunting and even frustrating, you will find that I have worked hard to make things easier. If you have any questions, please let me know when I see you at your appointment.

These forms protect your privacy and help me to serve you better. They ensure that we'll be able to meet without worrying about obtaining payment or insurance information from you every time you visit.

I know it looks like a lot, but if you take it one page at a time, you'll be through all this before you know it!  

Welcome to my practice!  This form tells you more about me and the policies of my practice.  You can read it here at the website, no need to print it.

Personal History  This is the longest form of the lot!  It takes a few minutes to complete, but provides me with a wealth of information.

Consent to Treatment  This form states that you agree to my practice policies.  

Rights and Responsibilities  This form spells out what your rights and responsiblities as my client are. 

Communication with Physician  Some insurance companies require me to have contact with a client's physician.  Sometimes clients or physicians request that I provide information.  This form permits me to have contact with your physician, if you choose to allow that. If not, please sign it at the designated spot to say that information sharing is not permitted.

HIPAA  This form explains what HIPAA is.  You probably have seen it many times at your doctor's office.

Consent Form  This form allows me to bill your insurance, and permits me to share with your insurance company that you received services. 

Credit Card  My policies state that if you have no showed or late canceled, payment is expected.  This form authorizes me to place a charge on your credit card in your absence.  We can talk about this further if you have any questions. I will shred this form after our work together is completed.

Third Party Payments   If I am receiving credit card payment from a spouse, significant other or parent, I need to have this authorization completed.