Forms


There are several forms you will need to fill out before beginning therapy. You can also review my policies regarding confidentiality, disclosures, treatments, fees and more by reading the Policies and Fees section.

General Procedural Information and Informed Consent

This downloadable PDF details the procedures for the initial session, scheduling and cancellations, fees, insurance information, payment, therapy, confidentiality and emergency coverage.

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Disclosures and the Health Insurance Portability and Accountability Act (HIPAA)

This downloadable PDF details information disclosure for treatment, the patient’s rights, the psychologists duties, questions and complaints about HIPAA, and restrictions.

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Acknowledgement of HIPAA Notice

This downloadable PDF is an acknowledgement that you received a copy of the Maryland Notice of Privacy Rights as outlined under the Health Insurance Portability and Accountability Act.

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Confidential Information Sheet

This downloadable PDF contains demographic and other data collected by the psychologist.

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