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.
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: