Intake Form & Teletherapy Consent Form & HIPAA
The attached Intake Form requests basic information about
you and the reason you’re seeking psychotherapy. The more detailed information you provide, the more it will facilitate the initial evaluation session.
The Teletherapy Consent Form enables our working via video-conferencing, and the HIPAA Form allows for our communicating electronically.
If you have emailed or called and scheduled an appointment, please download & sign all three forms and email them to svcarboni@lifechangeboston.com before our first session.
(PDF file, free Adobe Reader required)
you and the reason you’re seeking psychotherapy. The more detailed information you provide, the more it will facilitate the initial evaluation session.
The Teletherapy Consent Form enables our working via video-conferencing, and the HIPAA Form allows for our communicating electronically.
If you have emailed or called and scheduled an appointment, please download & sign all three forms and email them to svcarboni@lifechangeboston.com before our first session.
(PDF file, free Adobe Reader required)
| Intake Form |
|
| ||||