|You are highly encouraged to download the following PDF Forms, fill them out completely, and bring them in with you to your first appointment. This will streamline the registration process and allow your provider to spend more time discussing your concerns during the first appointment. To download each form, simply click on the link provided with the name of each form.Note, if you do not already have Adobe Acrobat Reader®, please click this the PDF symbol here to download a FREE VERSION of this important program.
|NAME OF FORM
| Registration Form
||This form lists basic demographic and contact and demographic and insurance information for the client and guarantor(s) as applicable.
| Office Policies Form
||This form describes the policies for Dr. Parisi & Associates, P.C. including discussion of billing, claims submission, and cancellations.
| HIPAA Rights and Attestation
||This form discusses privacy rights and ownership of medical records as described in the Health Insurance Portability and Accountability Act (HIPAA, 1996).
| Credit Card Authorization Form
||This form is used keep a copy of a valid, active credit / debit card on file and is used to ensure that overdue account balances are paid in full. All clients of Dr. Parisi & Associates, P.C. are required to complete this form as a good faith guarantee of account payment.
|Psychosocial History Questionnaire
||This form provides an overview of clients’ personal history including a description of the presenting problem(s), psychiatric, medical, vocational, academic, and social histories.