Forms

 

Please complete all relevant forms before your first appointment and email to tammypoc@gmail.com

 
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Patient Registration & Biography

Download

Couples Therapy Registration

Download

Download

Informed Consent for Telehealth


Informed Consent Service Agreement & Notice of Privacy Practices Acknowledgement

Download

Informed Consent Form

Download

Consent for Release of Confidential Information

Download

Authorization for Electronic Communication

Download

HIPPA Notice of Privacy Practices

Download