IMPORTANT: If you're a new client, you MUST PRINT, COMPLETE, & SIGN/DATE the following 13 (12 forms if not a child/adolescent patient) FORMS and bring them to your initial appointment (and at any appointment thereafter as requested):
- Informed Consent for Treatment
- Informed Consent for Limits of Confidentiality
- Statement of Financial Responsibility (1 of 2)
- Financial Statement for Prior Authorizations & Letters (2 of 2)
- Cancellation Notice
- Developmental History Questionnaire (parents please complete for child/adolescent patient only)
- Self-Assessment Form
- HIPAA Notice of Privacy Practices
- HIPAA Privacy Signature Form
- HIPAA Privacy Request Form
- INFORMED CONSENT FOR TELEPSYCHIATRY
- IN-PERSON APPOINTMENTS INFORMED CONSENT DUE TO COVID
- IN-PERSON APPOINTMENT WAIVER DUE TO COVID
**INFORMATION FOR PATIENTS: Duty to Warn NJ Law (Updated by NJ governor in June 2018)
This is so I can give you the best treatment that you certainly deserve!
Thank You,
Dr. Hraniotis, M.D.