CLIENT FORMS

Please make sure to review and sign these forms at least 24 hours prior to your first appointment. 

Privacy Practices

In Case Of Emergency

Informed Consent, Practice Policies, Consent for Telehealth: Lauren Reminger

It is our policy to have a credit card on file. Your card will automatically be charged at the time of service.

Payment Information & Authorization

To increase transparency in healthcare billing as required by the “No Surprises Act”, effective January 1, 2022.

Good Faith Estimate For Health Care Items & Services: Lauren Reminger

Please complete, sign and return this form if you would like to authorize the release of Personal Health Information.

Authorization For Disclosure of Health Information

Consent For Telehealth Consultation

Consent For EMDR Treatment

Consent For Observation

Consent For Treatment Of A Minor

Reduced Fee Application

Getting Started With Teletherapy