NEW PATIENT PACKET
Once our office has scheduled your initial evaluation appointment, please print out and complete this packet. These forms are pretty lengthy so we recommend filling them out prior to your appointment and bringing them with you. Alternatively, you're welcome to arrive 30 minutes early and complete them in our office. This packet includes an Acknowledgment of Receipt of our Privacy Practices. You're welcome to read about our privacy practices here.
RELEASE OF RECORDS AUTHORIZATION
Our Authorization to Release Confidential Information form is used for allowing our office to retrieve protected records from another medical or mental health provider and/or release your protected records to another person (another provider, family member, attorney, or disability service for example.)
NOTE: It's important to fill this form out in its entirety and include an original signature so we're able to obtain or release your protected personal health information.
Because we adhere to more stringent guidelines for protecting our client's personal health records, all requests must include the client's (or parent/guardian) original signature.