Please download the Information, History, Disclosure and HIPAA forms by clicking inside the box. (Forms can not be completed on line.)
General information about you including your address, any medications you are taking and insurance coverage.
Demographic data about you such as family of origin,
marriage(s) and children, as well as reason for seeking treatment.
The law requires that you are presented with information about your therapist and his/her treatment approach as well as office procedures, confidentiality, and termination of treatment.
Print and sign PAGE 6 only. Federal law requires that you are informed about how your health care information will be protected.
