CHILD AND ADOLESCENT PSYCHOLOGY PROFESSIONALS
  • Welcome
  • About Dr. De Simone
  • About Dr. Outhier
  • About Dr. Pieknik
  • Speech and Language Therapy
  • Client Forms
  • FAQ's

Client Forms

IMPORTANT: All NEW clients, please download and complete the CAPP Background Questionnaire prior to your FIRST appointment along with the appropriate Consent Forms.


Forms for Dr. De Simone
hipaa_notice_of_privacy_practices_updated_des_9-23-1322.pdf
File Size: 1231 kb
File Type: pdf
Download File

client_rights_9-23-136.pdf
File Size: 1160 kb
File Type: pdf
Download File

capp_release_form_des.pdf
File Size: 54 kb
File Type: pdf
Download File


Forms for Dr. Outhier
capp_hippa_v.2.pdf
File Size: 125 kb
File Type: pdf
Download File

client_rights.pdf
File Size: 75 kb
File Type: pdf
Download File

capp_release_form.pdf
File Size: 54 kb
File Type: pdf
Download File


General Forms
capp_background_questionnaire_web.pdf
File Size: 99 kb
File Type: pdf
Download File

capp_information_rights__responsibilities.pdf
File Size: 116 kb
File Type: pdf
Download File

capp_accompanying_adult_and_limited_consent.pdf
File Size: 46 kb
File Type: pdf
Download File

collateral_consent.pdf
File Size: 90 kb
File Type: pdf
Download File

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