Client Forms

If you are a new client, please download and complete the following forms. You may send the completed forms to janstone@hushmail.com

Client Registration

Client Registration Form
Client HIPAA

Client HIPAA Form
Client Informed Consent

Client Informed Consent
Client Registration

Client Coordination of Care Medical Information
Release of Information

Release of Information
Payment Authorization

Payment Authorization
Telemental Health Consent

Telemental Health Consent
Disclosure Notice Regarding Patient Protections Against Surprise Billing

Disclosure Notice Regarding Patient Protections Against Surprise Billing
Currently accepting new clients on a waitlist