Information for Out-of-State Clients

  

  

What To Do

  

For out-of-state clients, simply print out the relevant forms below, complete, and return them to me. The HIPAA statement is for your information only. I need you only to return the signature form acknowledging that you have received my privacy statement. Only one consent form is needed, either the one for individuals or for family. The Release of Confidential Information Form is needed if you want me to be able to converse with anyone, whether a spouse or another professional.

Document Forms to Download

Disclosure/Consent Form for Individuals
Disclosure/Consent Form for Family Sessions
HIPAA Signature Form
HIPAA Privacy Statement
Initial Assessment Short Form
Release of Confidential Information Form