Desiree Murray, LCSW, CAC III

Forms

If you have scheduled an appointment with Desiree, please complete the Online Pre-Registration.
Pre-registration Form

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Disclosure Statement

HIPAA Form

Consent To Communicate PHI Electronically

Credit Card Authorization

If you would like for me to have contact with a third party regarding your treatment please print and complete this release of information form.

Release of Information Form

Additional forms

EMDR Consent Form

Permission To Video