Please complete the following forms.*
Please email the forms to email@example.com before the initial meeting.
1. Notice of Privacy Practices of HIPAA
2. HIPAA Acknowledgement of Receipt
3. Professional Disclosure Statement/
Informed Consent Face to Face
5. Adolescent Intake Form (adolescents only)
6. Credit card Authorization Form
*Services will be provided only after forms were received.
*Please use a PDF program to fill these forms.