Brandon Area Psychology Associates, LLC

Consent forms for Dr. Jeanne Peterson-Brandon Area Psychology Associates, LLC
Intake Forms (please complete and bring to first session)
Client Registration Form (all clients)
Client Services Agreement (all clients)
Adult Questionnaire (adult clients only)
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/or a 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