Patrick Tassoni LCPC - Certified Daring Way Facilitator Candidate

Counseling Services for Adolescents, Adults, and Groups

 Forms

After our initial phone conversation, we will agree on a time to meet and get to know one another. If you decide to work with me, I will send you some initial forms to complete.  Using a paperless HIPAA compliant electronic medical records system, you will receive an email containing the forms below which you will need to electronically sign.  

The forms you will need to fill out include: 

HIPAA Notice of Privacy Practices

Private Practices Notice- (Signature Page)

Limits of Confidentiality

 

Adolescent/Child Informed Concent Form

 

If you would like me to coordinate care with another provider, such as your psychiatrist, family physician, or school support professional, I will send you a paperless Authorization to Disclose Information Form. Once you receive the electronic form, you will sign it and I will then be able to send it to the appropriate provider in order to share pertinent information and coordinate your care.

 

Authorization to Disclose Information Form

 

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