If you’re a new client, please follow instructions in sections A, B and C and complete the forms and bring them to your first session.
For psychotherapy, please print and complete the following forms:
For nutrition therapy, please print and complete the following forms:
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form for each healthcare provider you authorize me to release information to:
Please return to the menu and go to the Privacy page to read about Healthy Lifestyles PLLC’s HIPPA information for all clients. Please print out the Acknowledgement of Receipt of HIPPA policies and Breach of Information forms below and bring them with you to your first session.
- Notice of Privacy Practices Receipt and Acknowledgment of Notice
- Contact by Telephone/Verbally in Event of Breach of PHI
- HIPPA Policies
Thank you. Completing this first step before we meet will help us to spend more time discussing the issues you are struggling with in our first session.