Forms

Client Portal ButtonI use an electronic practice management system, and ask that all clients register via the secure client portal of my website. Downloadable hard copy forms are provided here for those who are unable to register online.

 

First Appointment Forms

Signing typewritten form
THIS PACKET CONTAINS ALL THE FORMS IN FILLABLE PDF FORMAT NEEDED FOR YOUR FIRST APPOINTMENT. The following forms are included: Client Information Form, Informed Consent & Policies and Practices, and Billing Information and Consent. The completed forms should be given to Dr. Warner at your first appointment. If you only need one of the forms, they are available individually below.

 

Client Information Form

Client demographics and contact information form in fillable PDF format. The completed form should be given to Dr. Warner at your initial appointment.

 

Billing Information and Consent

Billing and insurance information form in fillable PDF format. Contains payment and insurance policies as well as late cancellations and missed appointments policy. The signed Billing Information and Consent document should be given to Dr. Warner at your initial appointment.

 

Credit Card Authorization Form

Credit card authorization form in fillable PDF format. Provides authorization for charging of any and all payments, copayments, coinsurance, deductibles, missed session fees, late cancellation fees, or outstanding balances on your account that have not otherwise been collected. The signed Credit Card Authorization Form should be given to Dr. Warner at your initial appointment.

 

Informed Consent & Policies and Practices

Notice of Dr. Warner’s policies and practices to protect the privacy of your health information. This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully and keep it for your records. The signed Authorization and Informed Consent document should be given to Dr. Warner at your initial appointment.