Brandon Area Psychology Associates, LLC

Consent forms for Dr. Laura Dincer-Brandon Area Psychology Associates, LLC
Intake Forms (please complete and bring to first session)
Client Registration Form (for parents to complete)
Client Services Agreement (for parents to complete)
Child/Adolescent Questionnaire (for parents to complete)
Adult/Intake Questionnaire (for adult clients to complete)
Supervision Disclosure (for parents or adult clients to complete)
Notice of Privacy Practices (Read only-no signature needed)
Authorization to Release/Obtain Protected Health Information Form (recommended to coordinate care-allows us to speak with teachers, health care professionals etc...)

Additional Consent Forms (may be required if the following criteria is met)
Separated/Divorce Agreement Form (required if client is a minor and a parental divorce/separation has occurred)
Consent for Independent Child Attendance (required if client is a minor and a parent/legal guardian is not on premises)
Consent for Child to be Transported to Session by another Adult (required if client is a minor and brought to session by a non-family member adult)
*These forms are not to be reproduced, copied or altered without the expressed written consent of Brandon Area Psychology Associates, LLC