Forms

You may download my practice forms here, print them, and bring them in to our first session. Note that some forms are required, others are optional, some have different versions depending on the type of treatment, and some are just for your own information and do not need to be given to me. If you are unsure which ones you should fill out, contact me.
SelectionFile type iconFile nameDescriptionSizeRevisionTimeUser
SelectionFile type iconFile nameDescriptionSizeRevisionTimeUser
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View Download		 OPTIONAL. Print, fill out and sign if you want to give me permission to exchange information with other persons (other mental health professionals, teachers, etc.).   145k v. 3 Jan 21, 2013, 4:27 PM Eric Kelly
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View Download		 REQUIRED IF I WILL BE BILLING YOUR INSURANCE. Print, fill out and sign if you want me to bill your insurance company.  193k v. 3 Jan 21, 2013, 3:38 PM Eric Kelly
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View Download		 REQUIRED. Print, review and sign.  175k v. 3 Jan 21, 2013, 3:38 PM Eric Kelly
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View Download		 REQUIRED. Print and sign this form to indicate that you have reviewed the Notice of Privace Practices.  145k v. 3 Jan 21, 2013, 3:31 PM Eric Kelly
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View Download		 REVIEW ONLY. This is the brief, plain English version of the Federal HIPAA privacy practices that I am required to follow.    145k v. 3 Apr 8, 2013, 9:29 AM Eric Kelly
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View Download		 REVIEW ONLY. This is full version of the Federal HIPAA privacy practices that I am required to follow.    174k v. 3 Apr 8, 2013, 9:29 AM Eric Kelly
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View Download		 REQUIRED - When the client is a child.  231k v. 3 Jan 21, 2013, 3:34 PM Eric Kelly
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View Download		 REQUIRED - When the client is a couple or multiple family members.  197k v. 3 Jan 21, 2013, 3:34 PM Eric Kelly
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View Download		 REQUIRED - When the client is an individual adult.  197k v. 3 Jan 21, 2013, 3:34 PM Eric Kelly