Paperwork

Resources Center for Compassion

Scroll down to find the paperwork requested:

Disclosure and Questions

To save time on our first visit, please click “Disclosure” and “Some Questions” to gain access to the pdf links below. Then please print, and complete the forms.

Please bring both “Disclosure” and “Some Questions” with you when you come in.

Please print, read and sign these documents:

Disclosure Statement, Methods and Rate Scale

Please print and complete: 

Some Questions

Videoconferencing

In the event that we decide together to meet through videoconference, please click on the PDFs below, then read, sign and complete the “Consent for Telehealth.” 

Please print, read and sign the following consent:

Consent for Telehealth

Please read the following information regarding Doxy.me below:

Instruction and Tips for Doxy.Me

Information and Rate Scale Update

About every two years, I increase the rate scale slightly for cost-of-living. At that time, I also ask to update information for my files. Please click on the PDF link below and print, complete and sign when requested.

Please print, complete and sign the form below.

Information and Rate Scale Updates 2022 – 2023 

Authorization to Release or Request Information

If it has been requested that I speak on your behalf to another health professional, please print, read and sign the following release:

Authorization to Release or Request Information

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