PRACTICE INFORMATION AND CONSENT FORMS
NOTICE OF PRIVACY PRACTICES
This helpful document will give you all the information you'll need to understand how we handle and secure your confidential information. Note that, upon visiting, you will be asked to sign a statement acknowledging that you understand the material here. I will go over the important elements of the document with you in person, but I have provided the full text for your reference here. I'd be more than happy to provide a paper copy, just ask!
TELEMENTAL HEALTH INFORMATION AND CONSENT FORM
This document details how I employ telemental health technologies to keep your privacy protected and your continuity of care consistent during remote sessions.
CONSENT FOR TREATMENT
This document gives me permission to perform treatment.
CONSENT FOR NEUROPSYCHOLOGICAL EVALUATION
This document gives me permission to perform a neuropsychological evaluation.
AUTHORIZATION TO OBTAIN INFORMATION
This form is required if I need to obtain medical records from your other medical care professionals. This will make sure we can have a team effort in your treatment.
AUTHORIZATION TO RELEASE INFORMATION
This form is required if I need to share information with your other medical care professionals.