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Paperwork to Complete Prior to Your First Visit

Some initial paperwork is necessary before we can begin services. We will have more time to discuss the issues for which you are seeking assistance if you review and complete the required forms in advance. If you have any questions about the paperwork, feel free to to discuss them with me when we meet. Please print the relevant forms, complete them, and bring them to your first appointment. The forms are in PDF format.

Click on the icon to the left to download a free copy of Adobe Reader.

1. Client Information Form
This is a three-page form that provides me with your contact information, insurance information, and reasons for seeking help.

Instructions: All clients must complete this form. Please sign the insurance page to allow me to bill for your services. If you are not filing insurance, leave the insurance page blank.

2. Informed Consent to Psychological Services Form
This form provides you with an overview of your rights and responsibilities as a client, as well as my general office policies and procedures.

Instructions: Keep the form, but please sign and return the agreement on the last page. Be sure you understand the entire document before signing.

3. Notice Regarding the Privacy of Your Health Information
This form gives you information about how the privacy of your health information is maintained.

Instructions: Keep the form, but please sign and return the last page acknowledging that a notice of my policies and practices related to protecting your health information has been provided to you.

4. Release of Information Form
This form is OPTIONAL and is only completed when you want me to disclose information to some else (e.g., your physician) regarding your case.

Instructions: Check what information you want to release, to whom, and for what duration of time. Be sure to provide me with enough contact information so that I can get in touch with the individual with whom you want me to communicate.

5. United Behavioral Health Adult Wellness Assessment
NOTE TO CLIENTS COVERED BY UNITED BEHAVIORAL HEALTH:
As of December 1, 2005, UBH is requesting (not requiring) that clients complete a Wellness Assessment for the initial visit. If you have concerns about completing this form, please discuss them with me or with a UBH representative available at the number on the back of your insurance card.

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Credit Card Payment

For your convenience, payment for bills over $50 can be rendered securely online. Please note that you must sign a payment consent form in my office prior to using this service.

The accuracy of health information obtained from the Internet cannot be guaranteed. You are advised to make health decisions in consultation with your healthcare professional.

Useful Links

American Council on Exercise
The ACE Web Site is a resource for people interested in information about safe and effective exercise. More than 80 different editions of ACE Fit Facts are available free to the public. Clear, concise, one-page fact sheets covering a multitude of fitness issues, ACE Fit Facts are distributed through our Web Site, via Fax on Demand and through hundreds of health fairs and community events throughout the country

American Diabetes Association
The American Diabetes Association is the nation's leading nonprofit health organization providing diabetes research, information and advocacy. The mission of the organization is to prevent and cure diabetes and to improve the lives of all people affected by diabetes.

To fulfill this mission, the American Diabetes Association funds research, publishes scientific findings, provides information and other services to people with diabetes, their families, health care professionals and the public. The Association is also actively involved in advocating for scientific research and for the rights of people with diabetes.

American Fertility Association
The American Fertility Association (AFA) and works to transform the lives of couples faced with infertility, raise awareness and fight for social and legislative change around infertility issues. The AFA's purpose is to educate the public about reproductive disease, and support families during struggles with infertility and adoption. The AFA exists to serve the unique needs of men and women confronting infertility issues.

American Heart Association
The American Heart Association is a national voluntary health agency whose mission is to reduce disability and death from cardiovascular diseases and stroke.

American Psychological Association
The American Psychological Association is the world's largest organization of psychologists. Useful information about coping with life's problems can be found at the Consumer Help Center.

American Society for Reproductive Medicine
ASRM is an organization devoted to advancing knowledge and expertise in infertility, reproductive medicine and biology. ASRM Resources for Patients provides information on infertility, menopause, contraception, reproductive surgery, endometriosis, and other reproductive disorders. There is also a page addressing frequently asked questions about the Psychological Component of Infertility.

Brain Injury Association of America
The Brain Injury Association of America was founded in 1980 by a group of individuals who wanted to improve the quality of life for their family members who had sustained brain injuries. Despite phenomenal growth over the past two decades, the Association remains committed to its grassroots. The Brain Injury Association of America encompasses a national network of more than 40 chartered state affiliates across the country, as well as hundreds of local chapters and support groups. The San Antonio chapter is the Alamo Head Injury Association.

Health Finder
Healthfinder® is an award-winning Federal Web site, developed by the U.S. Department of Health and Human Services together with other Federal agencies. Since 1997, healthfinder® has been recognized as a key resource for finding the best government and nonprofit health and human services information on the Internet. healthfinder® links to carefully selected information and Web sites from over 1,800 health-related organizations.

National Cancer Institute
The National Cancer Institute coordinates the National Cancer Program, which conducts and supports research, training, health information dissemination, and other programs with respect to the cause, diagnosis, prevention, and treatment of cancer, rehabilitation from cancer, and the continuing care of cancer patients and the families of cancer patients.

National Rehabilitation Information Center for Independence
NARIC is committed to providing direct, personal, and high-quality information services to anyone interested in disability and rehabilitation issues. NARIC's Instant Disability Information Center allows you to search a huge collection of federally funded research projects, books, and articles.

Mayo Clinic
This site has information and tools for improving your health. There is also information on various medical issues and guides to help you make decisions about your treatment, from one of the premier medical centers in the world.

MyPyramid.gov
This is the USDA website that provides detailed information about the government's new food pyramid that incorporates exercise and individual caloric needs. The food pyramid was changed in response to the government's concern regarding the increasing weight of Americans.

Resolve: The National Infertility Association
Resolve is The National Infertility Association and has a nationwide network of chapters. It is a dynamic organization dedicated to providing advocacy, education, and support for men and women facing the crisis of infertility. The South Texas chapter (http://www.resolveofsouthtexas.org) serves the San Antonio area.

Spine-health.com
Spine-health.com was developed by a group of medical professionals and aims to provide comprehensive, highly informative and useful resource for understanding, preventing, and seeking appropriate treatment for back and neck pain and related conditions.

USDA Center for Nutrition Policy and Promotion
The Center for Nutrition Policy and Promotion was created in the U.S. Department of Agriculture, December 1, 1994, and is the focal point within USDA where scientific research is linked with the nutritional needs of the American public.
The creation of the Center comes at a time when the American public is increasingly aware of the importance of diet, yet is receiving conflicting nutrition messages. The Center, therefore, will serve as a touchstone where the public is assured that the nutrition guidance they receive is based on sound research and analysis.