SECURE PORTAL

HIPAA Compliant Email Here

If you have scheduled an intake with Deirdre: Please download the intake packet, fill out, sign (electronically or print/sign/re-scan in), and send back through this HIPAA compliant, private email. In addition, if you are using insurance please attach pictures of the front and back of your insurance card, as well as fill out a HIPAA form for your insurance company. Please send all documents through this secure portal email - Click below to do so.

 

FORMS

Click to Download

HIPAA RELEASE FORM

This form should be downloaded and filled out for each person whom you want me to be able to share and receive information from. Please download this form if you have an intake with me and fill this out for your any person who may be paying for your therapy, any doctors you may want me to contact, if you are changing your emergency contact person, and fill it out for your health insurance/EAP you are utilizing for therapy. This form will need to be downloaded and filled out for each individual you want a release for.

This form was included in the Intake Packet for your emergency contact. Download extra for all other people or organizations you want me to be able to speak to.

 INTAKE PACKET: IF YOU HAVE AN INTAKE WITH ME PLEASE FILL THIS OUT IN FULL AND SEND IT BACK THROUGH THE SECURE PORTAL ABOVE.

Informed Consent: This form is the agreement that you enter into when you start receiving therapy from Deirdre.

Patient Rights and Provider Duties: This is an important document for understanding your rights and the responsibilities of the therapist.

HIPAA Release Form: This should be filled out for emergency contact person 

Telehealth Consent Form

Please read, sign and send back through secure portal above.

TELE-MENTAL HEALTH RELEASE (EXTRA: ONLY DOWNLOAD THIS IF YOU FORGOT TO FILL IT OUT IN THE INTAKE PACKET)

This is a telehealth consent. If you are seeing me by telehealth please fill this out and sign it and send it through the secure portal above.