Patient Registration

We are required by law to inform you about your privacy rights and you may click on Privacy Policy (HIPAA NPP) and download a copy or ask for a copy at our office, in addition we ask that you sign our Business Policy and Patient Agreement indicating that you have had this opportunity.

Download our Good Faith Estimate

Download our Informed Consent for Teletherapy Services   in order to schedule Teletherapy Services with your therapist.

Download our Consent for Returning to In-Person Psychological Services During COVID19 Public Health Crisis in order to prepare for in-person services.

Please take this time to read the information carefully, complete the forms and bring them with you to your first appointment.

    1. Patient Information Sheet for Child / Adolescent
    2. Authorization for Release or Exchange of Information
    3. Business Policy and Patient Agreement
    4. HIPAA NPP Signature Statement
    5. Informed Consent for Teletherapy Services
    6. Credit Card Authorization Form
    7. Financial Responsibility (Complete this form only IF someone else is assuming financial responsibility.)
    8. Special Contract (This is required IF parents are separated, divorced, pending divorce or engaged in litigation)

 

    1. Patient Information Sheet for College Students
    2. Authorization for Release or Exchange of Information
    3. Business Policy and Patient Agreement
    4. HIPAA NPP Signature Statement
    5. Informed Consent for Teletherapy Services
    6. Credit Card Authorization Form
    7. Financial Responsibility Form (Complete this form only IF someone else is assuming financial responsibility.)