Forms:

Dr. Lorna Benbenisty Forms:

  1. Professional Services Agreement
  2. Georgia Notice
  3. Client Information and Registration
  4. Collateral Contact (Non-Patient) Agreement
  5. Collateral Contact (Non-Client) Client's Consent And Agreement
  6. Information, Authorization, and Consent to Telemental Health
  7. Good Faith Estimate Notice

Dr. Audrey Bloom Forms:

  1. Professional Services Agreement
  2. Georgia Notice
  3. Client Information and Registration
  4. Patient Questionnaire
  5. Collateral Contact (Non-Patient) Agreement
  6. Collateral Contact (Non-Client) Client's Consent And Agreement
  7. Information, Authorization, and Consent to Telemental Health
  8. Good Faith Estimate Notice
  9. Authorization To Release Information

Dr. Sonja Contin Forms:

  1. Professional Services Agreement
  2. Georgia Notice
  3. Patient Questionnaire
  4. Authorization To Release Information
  5. Collateral Contact (Non-Patient) Agreement
  6. Collateral Contact (Non-Client) Client's Consent And Agreement
  7. Information, Authorization, and Consent to Telemental Health
  8. Good Faith Estimate Notice

Dr. Saori Maruyama Forms:

  1. Professional Services Agreement
  2. Georgia Notice
  3. Child Client Information and Registration
  4. Child Self-Report Information
  5. Adult Client Information and Registration
  6. Japanese Client Information and Registration
  7. Collateral Contact (Non-Patient) Agreement
  8. Collateral Contact (Non-Client) Client's Consent And Agreement
  9. Information, Authorization, and Consent to Telemental Health
  10. Good Faith Estimate Notice

Dr. Diane Sperry Forms:

  1. Professional Services Agreement
  2. Georgia Notice
  3. Client Information and Registration
  4. Collateral Contact (Non-Patient) Agreement
  5. Collateral Contact (Non-Client) Client's Consent And Agreement
  6. Information, Authorization, and Consent to Telemental Health
  7. Good Faith Estimate Notice