New clients should print and complete these forms:
PLEASE PRINT OFF RELEASE OF INFORMATION if you have a doctor, school, former therapist, etc that you need to give me permission to contact. Humana insurance requires a release of information to your PCP or Psychiatrist
DEVELOPMENTAL HISTORY FOR PARENTS TO COMPLTE FOR CLIENTS UNDER 18
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HUMANA CLIENTS
Humana requires that my charts include a release of information to your primary care physician and a listing of all your medications with dosage amounts. EATING DISORDER CLIENTS If you are being seen for eating disorders please bring all of the above forms plus current height and weight and some documentation from you MD that your weight has been or will be monitored. If you have seen a therapist or been in a treatment program for an eating disorder, I will need your treatment summaries or permission to contact the provider. If your eating disorder is more serious, completed blood levels to ensure your medical stability will also be required. |
