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Patient Forms
September 7th, 2009
Hello, Before attending the first session, please fill out the “Intake Form” and the “Informed Consent.”
If you would like for me to speak with collateral resources, please fill out the “Exchange of Information Release” form.
If you will be submitting Superbills to your Insurance Company or if I am in direct contact with your Insurance Provider, you also need to fill out the Protected Health Information HIPAA Authorization Form (PHI).
These forms may not be used for any purpose other than for clients of Michael Uram, MA, LMFT without prior authorization.