Helpful Forms

Please complete to following forms for your appointment:

/userfiles/2079575/file/Disclosure Statement.pdf

/userfiles/2079575/file/Child Information Form(1).doc




If you would like me to coordinate care with another provider, psychiatrist or medical doctor please complete the following form userfiles/2079575/file/HIPPA Authorization Form.pdf

If you would like to preview a copy of our Privacy Practices, please view it here: userfiles/2079575/file/privacypractices.pdf

Note: To download Adobe Acrobat Reader for free, click here .

Helpful Forms

Click here to view and print forms for your appointment.

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