Talk It Out Dallas

Forms

For many years I did consent forms this way. Recently I have changed to online consent forms. They are the same content about privacy, consent, confidentiality, etc but can be read and agreed to through my Therapy Appointment system. Once we agree to meet I will send you an invitation from my Therapy Appointment system for you to sign in and complete the paperwork. Thank you

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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