Forms

These forms can be filled out and electronically/signed online and emailed directly to me, however they contain HIPAA protected information such as your date of birth and medication lists. Please be aware that email communication can be accessed by unauthorized people which compromises the privacy and confidentiality of such communication. Un-encrypted emails, such as this, are even more vulnerable to unauthorized access. If you prefer, you may print off these forms, fill them out at home and bring them to our first session.

Authorization For Release of Medical Records

Client Registration Form

Massachusettes Notice Form