Patient Forms

Patient Privacy Notice

The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that provides new privacy protections and new patient rights with regard to the use and disclosure of your Protected Health Information (PHI) used for the purpose of treatment, payment, and health care operations. This notice explains your rights and my responsibilities. You can read the notice here.

Psychologist Patient Agreement

My fees and policies and procedures are described in this agreement which you can read here.

Patient Signature of Notifications

Before our first appointment you must sign a statement indicating that you have read and understood the Patient Privacy Notice and the Psychologist Patient Agreement. You can download a copy of the Patient Signature Notifications form here. Please print and sign the form and bring it with you to the first appointment.