Online Pre-Registration 

 

After you complete the online registration please also complete the forms below, you can email them to Stephanie 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 

 

Stephanie'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

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Additional forms

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Permission to video tape sessions