Documents and Forms
BY CATEGORIES
THERAPY AGREEMENT AND CONSENT
Informed Consent for Therapy
Authorization Form for Treating an Adult
Treating a Minor
Consent Form for Treating an Adolescent
Consent Form for Treating a Minor
CONFIDENTIALITY
Adolescent Privacy in Therapy Defined
Adolescent Parent Privacy Agreement
Confidentiality & Security
HIPAA
HIPAA Acknowledgement Form
Privacy Policy for Minors
Privacy Agreement for Adolescents & Parents
COMMUNICATION PREFERENCES
Communication Preferences Form for Adults
Communication Preferences Form for Adolescents
Communication Preference Form for Minors
AUTHORIZATION FORMS
Authorization to Send Psychology Records
Authorization to Discuss Confidential Matters
Credit Card Authorization Form
PHONE SESSIONS
Phone Session Procedure
Phone Sessions – Emergency Plan
Updated Emergency Contact Form
New Patients
For your convenience the New Patient Forms are separated by categories. Dr. Federici will advise you when to complete the forms.
Select one:
Existing Patients:
If you need to update any information, these forms are available in the office, or you may download them here. Please bring the completed form into the office at your next appointment.
Select one:
Communication Preference
Authorization Forms
Phone Sessions Forms
DR. RICHARD FEDERICI
New Location
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