New Patients
Below are the forms and paperwork I use during the initial session. Please feel
free to download and review them or even print them out and bring them in
completed.
- Patient Information Form
- Policies Form
- Mandatory Disclosure Form
- HIPPA Notice of Privacy Practices
- Acknowledgment of Receipt
Patient Information Form
Personal information such as name, address, etc., as well as
medical information and history.
PDF
Word Document
Top of Page
Policies Form
A short review of standard office and practice policies, such as cancellation
fees, right to discontinue treatment, and so on.
PDF
Word Document
Top of Page
Mandatory Disclosure Form
Information required by Co state law to be disclosed at the initial treatment
session, including information on my license, training, professional degree, and
board certifications.
PDF
Word Document
Top of Page
HIPPA Notice of Privacy Practices
This packet describes how medical information about you may be used and disclosed
and how you can get access to this information.
PDF
Word Document
Top of Page
Acknowledgment of Receipt
This is a simple form you sign as indication that you recieved a copy of the
above 'Notice of Privacy Practices'.
PDF
Word Document
Top of Page
*You'll need the Adobe Reader to read the PDFs. You can download the latest version
here.
Top of Page
Home Page
