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Psychologist Session

HOW DO I GET STARTED?

Let's learn more about you. Here is the initial paperwork needed once you have officially made a time to meet with Deirdre. These forms must be completed well before the first therapy session.

Step 1: Fill out the Intake Packet. It is preferred you fill out the electronic signature copy but if there are glitches or you are having trouble - feel free to print, fill out, sign and either bring in or send through the secure portal below (or fax to number at bottom of the page). An Emergency Release Form is already included in this packet, but if you want to sign another one there is an option below to do that, as well.

Any other releases that need to be filled out for psychiatrists, spouses, parents, financially responsible parties must be filled out separately under HIPAA Release Form. If anyone wants to speak with your therapist at all - there must be a release and you may specify "need to know," "emergency only" or "full/open release."

Step 2: Please fill out the Credit Card Authorization Form.

Step 3: If you are using insurance please fill out the Headway/Alma Agreement.

Step 4: If you are using insurance please send a copy of the front and back of your insurance card through the HIPAA Compliant Secure Portal below.

Step 5: Please download and fill out the Questionnaires and bring them with you to the first therapy session.

You will get a reminder for your first appointment the day before your appointment. If you choose Telehealth then Deirdre will send you a link the day before, along with a reminder. Your first appointment will consist of a one hour long mental health assessment and all following sessions will typically be one hour.

Forms & Secure Portal: About Therapy

SECURE PORTAL

HIPAA Compliant Email Here

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.

This portal is also the best way to send Deirdre a confidential email.

Forms & Secure Portal: Text

FORMS

Electronically Sign the Forms Below

If you have an intake with Deirdre please fill out and sign the forms below before your first appointment. These forms will be sent directly to Deirdre through the secure portal.

EMERGENCY 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.

DOWNLOADABLE QUESTIONNAIRES





These questionnaires will help Deirdre gain a better understanding of how to help

INTAKE PACKET

This packet will need to be filled out in its entirety. Please read it over and, if you agree, sign each page that requires it. 

In this packet is an extra HIPAA Release form for any person or organization you may want me to have contact with. Examples of these are insurance companies I need to contact, doctors you may want me to correspond with, or a family member who may be helping you pay.


You may leave the HIPAA form in this packet blank if you do not want any more releases of information.

More HIPAA forms are available upon request.

DOWNLOADABLE INTAKE PACKET





This packet is the exact same as the packet to the left. (Only one needs to be filled out). 

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.  

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.

HIPAA RELEASE FORM



This form is exactly the same as the one to the left. This form has the capability of electronic signature. It will be automatically sent to Deirdre when signed and submitted.

CREDIT CARD AUTHORIZATION FORM

Please fill out and sign below for billing purposes.

HEADWAY/ALMA AGREEMENT

All current clients please fill this form out and sign electronically if you agree to the new policy changes.

Forms & Secure Portal: Files
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