Patient Forms

If you are a new patient, please fill out the following forms prior to your appointment. Please note that you can complete these forms online, save the file, then email them to me prior to your appointment.

Informed Consent For Treatment

Your agreement and consent to participate in psychiatric services. Click here.

Notice Of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information. Click here.

Patient Registration Form

Patient contact information and health insurance information. Click here.

Patient Rights And Responsibilities

Your rights, responsibilities, and expectations as a patient defined by the Health Insurance Portability and Accountability Act (HIPAA). Click here.

Policies & Practices

Acknowledgement of receipt of policies regarding confidentiality, informed consent statement and patient rights and responsibilities. Click here.

Release of Patient Information

Authorization of the release of your medical information that might relate to the patient’s mental health and/or substance abuse treatment. Click here.

Schedule
an Appointment
Online

It’s fast, easy & simple

Meet with Deb

Schedule
an Appointment
Online

It’s fast, easy & simple

Meet with Deb