Header image
Reid Whiteside, P.C.
  
Contact Info | Location & Hours | Insurance Info | About Me
 
 
 
 

 
 
Forms and Information for Patients

Policies and Practice Information for New Patients
 1. Notice of Healthcare Information Privacy Rights
 2. Doctor-Patient Psychological Services Contract
 3. Contact Information
 4. Policy for Psychotherapy with Children/Adolescents 

Forms for all new Patients
 1-a. Patient Contact Information 
 1-b. Submit Patient Info Online Securely
 2-a. Insurance Information/Claims Authorization
 2-b.  Submit Insurance Info Online Securely
 3-a. Contract Master Signature Page- Adults
 3-b. Contract Master Signature Page- Child/Teen
 4. Authorization to Release/Exchange Information 

Misc. and Special Use Forms  
 1. Financial Responsibility in Legal Matters
 2. Disclosure of Patient Accounting Information
 3. Provisions for Litigation During Child's Therapy
 4. Policies Specific to Subpoenas, Depositions, Affidavits and Testimony



 

 
 
About Me | Site Map | Privacy Policy | Contact The Webmaster | ©2011 Reid Whiteside, P.C.