Forms

 
 

New clients who have scheduled an initial appointment with Dr. Daniel may complete new client paperwork online through the client portal. An invite to the client portal will be sent to the email address on file ahead of the initial appointment. Please reply to the email link if it has expired and you need it resent. Copies of these forms are available below. Not all of these forms may be required for every client.

New Client Information Packet

Authorization for Release of Medical Information

Client Rights and Responsibilities Statement

Notice of Privacy Practices HIPPA

Credit Card Authorization/Billing Policies

Insurance Inquiry Form

Private Pay Agreement