Patient Forms
This page contains important forms for you to read, complete, and bring to your appointment. Please follow the instructions below carefully.
1. Open and print the Signature Sheet.
2. Open and read the Patient Privacy Notice. Then, sign and date the Signature Sheet indicating that you have read and understood this notice. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that provides privacy protection and patient rights with regard to the use and disclosure of your Protected Health Information (PHI). This notice explains your rights and my responsibilities.
3. Open and read the Psychologist-Patient Agreement. Then sign and date the Signature Sheet indicating that you have read and unstrstood this agreement.
4. Complete the bottom portion of the Signature Sheet and bring this form with you to your appointment.
5. Open and print these questionnaires, and bring these completed forms with you to your appointment. They will help me with my initial assessment
6. If you would like to authorize me to speak with or release information about you to another person (such as a doctor or family member), open and print the Authorization to Release Form and bring it completed to your appointment.
7. Open and print Directions to my office.
Thank you! Please contact Dr. Abramowitz with any questions about these forms.
1. Open and print the Signature Sheet.
2. Open and read the Patient Privacy Notice. Then, sign and date the Signature Sheet indicating that you have read and understood this notice. The Health Insurance Portability and Accountability Act (HIPAA) is a federal law that provides privacy protection and patient rights with regard to the use and disclosure of your Protected Health Information (PHI). This notice explains your rights and my responsibilities.
3. Open and read the Psychologist-Patient Agreement. Then sign and date the Signature Sheet indicating that you have read and unstrstood this agreement.
4. Complete the bottom portion of the Signature Sheet and bring this form with you to your appointment.
5. Open and print these questionnaires, and bring these completed forms with you to your appointment. They will help me with my initial assessment
6. If you would like to authorize me to speak with or release information about you to another person (such as a doctor or family member), open and print the Authorization to Release Form and bring it completed to your appointment.
7. Open and print Directions to my office.
Thank you! Please contact Dr. Abramowitz with any questions about these forms.
