|
-Before your first appointment, you might want to read about my office policies, your rights as a patient, and you might like to save session time by filling out information in advance. Either bring the forms with you, or feel free to scan and email them to kathryngwhite@mac.com.
If you prefer, Dr White can give you the forms on paper at your first appointment . At times people consult with me for reasons other than psychotherapy, such as other mental health professionals seeking consultation, employers seeking advice related to workplace issues, people seeing help with life transitions, creative process, or other non health related issues. Since these consultations are not psychotherapy, they will be addressed with other agreements. Contact Dr White if you fit one of these other situations. The following forms are for people seeking psychotherapy. Forms All are in PDF form, which you can read and print yourself from here. If you read and fill them out in advance that will leave more time during the first session for us to get to know each other. Some of these forms are related to legislated requirements, others to insurance company requirements. I do understand that it seems that every year more forms and more signatures are required at all your health care providers and usually without enough time to read. These are online so that you can have full access to read them without having to print anything you don't want to. There are two sets of forms: Forms for you to read and forms for you to fill out. Forms to Read Office Policies Using Your Insurance and Confidentiality HIPPA Notice of Privacy Practices Forms to Fill Out and Sign Forms for your first session are marked with an *. Some of these apply only to those with Magellan. If so the text will clarify. *Basic intake forms Includes Information about you, insurance, what you're looking for, signature form. If there are particular sections that don't apply or that you don't want to fill out that will not affect your ability to seek treatment. Just draw a line through to mark that you didn't miss them. All basic information and signatures are required however. Initial Appointment updateable Word form, or PDF printable version. Covid era forms! You do not need to return these, just note on the basic intake first page that you've seen and agree. *Required for video telehealth sessions Informed Consent forTelehealth *Required for in office sessions Informed Consent for In Office sessions. Release of Information Forms *Magellan Yale Health requires, other insurance companies recommend, that you either sign a release to allow your Primary Care Physician and I to communicate or explicitly opt out. PCP Release *In addition, Magellan Yale Health requires that I provide a copy of the Members Rights and Responsibilities Statement and get your and my signature, that I retain in your file. Patient's Rights Form required by Magellan Yale Health If you are being prescribed any medication by a psychiatrist, APRN or PCP, I strongly recommend that you sign a release to allow us to communicate to coordinate care and if you don't wish to, to explicitly note that. Prescribing Provider Release of Information If you have other health issues that you or your physician believe are impacted by stress, or that impact mood or anxiety, you may also want us to be able to communicate. You can use this form to allow that: Other Health Provider Release of Information General release to allow communication with others. (OPTIONAL At times a family member) Update of information forms: Use to update address, insurance, medications. PDF and Word |