Downloads

DOWNLOADS

New Patients:

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 can come to your first appointment 10 minutes early to complete the forms,the forms to Dr. Federici, or  print them out before your appointment and just please remember to bring them with you. There are only a two forms that you need to be completed. The rest are ‘Only As Needed’ forms, so don’t worry about them.

There are also  two documents  that you only need to read but don’t necessarily need to print out.  These are for informational purposes. They do not need to be signed. Both documents are concerning maintaining your privacy and confidentiality.  The first is CONFIDENTIALITY AND SECURITY. This document describes the measures of security and the office’s procedures. The second document is a handout with useful information on how to keep your private information safer. COMMUNICATIONS INFO HANDOUT It is meant to help you be more aware of general  precautions that you can take.

The forms you need  to print are CONSENT FOR THERAPY and COMMUNICATIONS PREFERENCE FORM  Dr. Federici believes that each person has the right to the level of privacy they feel comfortable. Everybody’s needs are different, so where ever possible, Dr. Federici wants you to to decide on the level of precautions you feel comfortable. The higher the level of security, the more stringent the procedures become.

PLEASE NOTE: If you are bringing in a child age 14 through 18,  please print and review these two additional forms as well:     Privacy Policy for Adolescents and  Adolescent & Parent Privacy Agreement   

IF THERE IS ANY PART OF THE FORMS THAT YOU ARE CONCERNED ABOUT – NO WORRIES. DR. FEDERICI WILL GO OVER IT WITH YOU.

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.

DOCUMENTS

Informed Consent for Therapy

Confidentiality & Security

How You Can Protect Your Privacy

Privacy for Adolescents

Phone Session Information

Phone Session Procedure

Phone Sessions – Emergency Plan

Informed Consent for Therapy

Confidentiality & Security

How You Can Protect Your Privacy

Privacy for Adolescents

Phone Session Information

Phone Sessions – Emergency Plan

Phone Session Procedure

FORMS

Communication Preferences Form for Adults

Privacy Agreement for Adolescents and Parents

Communication Preference for Adolescents 14-17

Communication Preference for Minors

Communication Preferences Form – Adults

Privacy Agreement for Adolescents and Parents

Communication Preference for Adolescents 14-17

Communication Preference for Minors

Authorization to Discuss Confidential Matters

Authorization to Send Psychology Records

Updated Emergency Contact Form

Credit Card Authorization Form

Authorization to Send Psychology Records

Mental Health Treatment of a Minor with Parent Authorization

Authorization to Discuss Confidential Matters

Updated Emergency Contact Form

Credit Card Authorization Form

Mental Health Treatment of a Minor with Parent Authorization