To maximize the full time of the session, please complete the top 3 forms prior to the first session. The HIPPA Notice of Privacy Practices is for you to keep.

Client Personal History

Golshid Fadakar Informed Consent

Notice of Privacy Practices-Receipt Acknowledgement

Hippa Notice of Privacy Practices

Authorization to Exchange Confidential Information

Authorization to Release Confidential Information

If client is under the age of 18, parent(s) and/or legal guardians are to sign the following form:

Informed Consent Minors