HIPAA Privacy Authorization Form
Authorization for Use or Disclosure of Protected Health Information
(Required by the Health Insurance Portability and Accountability Act ---- 45 CFR Parts 160 and 164)
Informed Consent Checklist for Telepsychology Services
Due to the unprecedented corona-virus crisis , our office has discontinued all face-to-face appointments. We will continue treatment through phone sessions or teleconferencing. Please complete the form below before your first telepsychology appointment.