Forms
Below are links to forms that are necessary for you to read to understand the nature and rules of my practice as well as your legal rights. Please read them carefully before our first meeting and sign the signature pages at the end of each form. I will be glad to answer any questions during our first meeting.
Practice Policies: logistics and details about my practice, such as fees, insurance, how to contact me, social media, cancellation policies and confidentiality.
HIPAA Notice of Privacy Practices: required by law, outlines federal and state mandated guidelines that provide protection for your health records and addresses the issue of confidentiality.
Informed Consent for Teletherapy: information & agreements relevant to technology, including Zoom meetings and email exchanges.
Authorization for Release of Information: gives me permission to exchange information with other therapists, providers or individuals whose insights and information could benefit our work.
Medicare Opt Out Private Contract: If you are over 65 and on Medicare Insurance, this form acknowledges your knowledge that I am not a Medicare provider.
Sign these pages, please
At the end of the lengthy Practice Policies, HIPAA and Teletherapy Consent forms are pages that require your signature. For your convenience, here are the signature pages which can be printed by clicking on the link below. Please scan and email those pages to me or print and mail them. Every member of a couple or family needs to sign each form.