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Talk It Out Dallas

Psychologist - Psychoanalysis and Psychotherapy

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Forms

Thank you for completing these hard copy forms. I am working toward a fully online version but I am not there yet.

Please print, read, and sign on pages 10 (informed consent), 12 (HIPAA privacy policy) and 13 (release of information –if you are using insurance and/or to release me to reveal any information with your physician, family member, friend or anyone else, etc.) You can write the insurance and family member on the same release form. (Note: First One is in pdf form and the other is a Word document form of the same packet).

New Patient Packet Dr Jason Berman updated 3.7.2019

New Packet Word Version

Thank you and see you soon.

JB

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© 2021 · Talk It Out Dallas · Jason S. Berman, PhD, CGP · Dallas Psychologist