Please print and complete the following forms and bring them with you to the first session:

• Intake Wellness Form
• Client Demographic Information
• HIPAA – Confidentiality Form
• Omni Psychotherapy Policies & Procedures Form
• HICFA 1500-90
• Credit Card Authorization Form
• Standard Notice and Consent Surprise Billing Protection Forms for Nonparticipating Providers

Please complete the form below if there are other service providers that should be contacted for collaborative purposes, e.g. prescribing psychiatrist, school guidance counselor or social worker, etc.

• Authorization for Release of Confidential Information