Office Documents - Dawn Stremel


	Office Documents

	If you have made an appointment to see me, please download and complete the following documents: Adults Print 2 copies of Disclosure Statement: Read and keep one for your personal records; initial and sign the other copy and bring to your first appointment. Print out a copy of the HIPAA Statement: Read and keep for your own records. Print out Adult Questionnaire Form: Fill out and bring to first appointment. Couples/Families Print 2 copies of Disclosure Statement: Read and keep one for your personal records; initial and sign the other copy and bring to your first appointment. Print out a copy of the HIPAA Statement: Read and keep for your own records. Print out Family & Couple Questionnaire Form: Fill out and bring to first appointment. Children/Youth Print 2 copies of Disclosure Statement: Read and keep one for your personal records; initial and sign the other copy and bring to your first appointment. Print out a copy of the HIPAA Statement: Read and keep for your own records. Print out Child/Youth Questionnaire Form: Parents fill out and bring to first appointment. Print out Child/Youth Mood & Behavior Rating Scale: Parents fill out and bring to first appointment.


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