Forms Adults

     Welcome! We live in a society that loves forms. We have forms for everything. Unfortunately, Dr. Federici’s office is no exception. Don’t be overwhelmed, you can come to your first appointment 10 minutes early to complete the forms, or if you prefer, please print them out before your appointment and bring them with you.

   THE DOCUMENTS:

• • • The Therapy with Dr. Federici document explains the office practices
    • The Confidentiality and Security document explains the procedures followed in Dr. Federici’s practice to protect your privacy. Everybody’s needs are different, so where-ever possible, Dr. Federici wants you to decide on the level of precautions you feel comfortable. The higher the level of security, the more stringent the procedures become. Dr. Federici believes that each person has the right to the level of privacy they feel comfortable
    • The HIPAA Policy
    • The Phone Session Procedure  document  explains under what conditions phone sessions may be offered, what your obligations are, and what the procedure is for teletherapy. PLEASE NOTE: if you will not be in New Jersey you may not schedule phone sessions

   THE FORMS:

    The following documents should be signed and returned to Dr. Federici:

1. 1. 1. 1. The Informed Consent for Therapy Form where you acknowledge receiving,  understanding, and agree to practice’s policies
         2. The Communication Preference Form where you state how you would like to be contacted
         3. The HIPAA Acknowledgement Form acknowledges that you have read the HIPAA practices
         4.  The Credit Card Authorization Form  where you authorize the use of your credit card. PLEASE NOTE: The preferred payment method is by credit card

IF THERE IS ANY PART OF THE FORMS THAT YOU ARE CONCERNED ABOUT

DR. FEDERICI WILL GLADLY REVIEW IT WITH YOU

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