Forms

Online Pre-Registration 

After you complete the online registration please also complete the forms below, you can email them to Jennifer before your appointment or bring completed to your first appointment. 

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Choose one of the following

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Client Information - Adult

Client Information - Child/Adolescent

Client Information - Couples/Family

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Complete all 

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Jennifer's Disclosure Statement

HIPAA Document

Consent to Communicate PHI Electronically

Credit Card Authorization

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Complete if you would like me to speak to another professional (Physician, Teacher, Etc.)

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Release of Information