If we have agreed to work with each other, please fill out these forms before your first session with me. Either bring them to your first session (if we are meeting in person) or scan and send them to me via email at firstname.lastname@example.org, before your first Virtual Therapy Session. Thanks!
Professional Service Agreement
Release of Information to Insurance Companies
Cancellation/Missed Appointment Policy
Patient’s Acknowledgement of Receipt of Privacy Notice
Medicare Private Contract Form
If you would like me to either talk to a previous therapist or for me to collaborate with one of the other therapists or prescribers you are currently seeing, please fill out this form.
Authorization for Request/Release of Information Form