Authorization to Communicate – Release of Information

Please print out, sign, and send me a copy of this authorization form to permit me to communicate with anyone regarding your care, i.e. medical doctor, psychiatrist, neuropsychologist, partner, etc.

No Surprises Act Rights

Please read the Notice of Consent document before starting our work together. Once we agree to engage in a professional relationship. I will send you the fee schedule and you will be asked to sign that you have read this document and the fee schedule.

Biographical Information

Please fill out this Biographical Information form and email a copy to me prior to our first contact/meeting.

Massachusetts Notice Form

Please read the Massachusetts Notice Form to learn about the privacy of your health information (HIPAA-protected rights).

Office Policies and Financial Information

Please read through my office policies and general information, services agreement (consent), then sign and email to me prior to or soon after our first meeting.