Forms

Privacy and Confidentiality Practices

Your privacy and right to confidentiality are protected by the law and the American Psychological Association's Code of Ethics.  All communications between a client and a psychologist are protected.  Information about you or your treatment cannot be disclosed without your consent. There are three exceptions to this rule:

  • In the case of suspected child abuse or dependent adult/elder abuse, we are required by law to notify the appropriate authorities

  • If a client threatens serious bodily harm to another person, we are required by law to notify the police and the intended victim

  • If a client threatens to cause imminent harm to himself or herself, we are required by law to ensure their safety

HIPAA/ Notice of Privacy Practices

We are required by law to provide you with a copy of our HIPAA Notice of Privacy Practices, so you can understand your rights and protections related to the use and disclosure of your identifiable healthcare information. For HIPAA information as it applies to our practice, download the Notice of Privacy Practices in PDF form here.

E-Mail and Electronic Communication

If we agree to correspond using electronic mail (E–mail), this form provides guidelines for the intended use of this type of communication and documents for your consent.