Please complete the forms below prior to our first meeting and bring them with you. If we are not able to meet in person you can email them to drstone@drheatherstone.com or fax to (866) 232-2355 prior to the first session. We will then go over them together and I will answer any of your questions or concerns.
Required Forms
- Patient Information Form
Complete and sign hard copy, or open in Acrobat for prompts. - Notice of Privacy Practices
Review, sign, and return signature page if acceptable. - Consent for Psychotherapy Services
Review, sign, and return signature page if acceptable. - Consent to use email or text
Please review, sign, and return form. - Payment-Authorization
Please complete if you wish to pay with credit card. - Telemedicine Informed Consent
Please complete if you wish to use interactive audio or video conferencing as a venue for psychotherapy.
Optional Forms
- Authorization to Release Information
Optional: Please add third party (e.g. other medical provider), sign, and return form. - Authorization to Release — Collateral
Optional: Please add collateral — supportive person(s), sign, and return form. - Psychotherapy Collateral Agreement
Required with form above: Collateral participants should read, sign and return this form…