NEW CLIENT FORMS
Welcome & Thank you for choosing me to deliver your care. I understand this process can seem intimidating and hope to make it as smooth as possible for you.
The following Forms are necessary to establish you as a client and to help me address your concerns. Please print, fill them out, and bring them to your initial consultation. If you are unable to download or access the forms online, they can be emailed to you. If you are unable to complete the forms in advance, please arrive 20 minutes early to fill out the paperwork prior to your scheduled appointment.
At your consultation, we will review the information you provide as well as answer any additional questions you may have. Thank you. I look forward to meeting you.
Privacy Practices:
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Downloadable Forms:
Welcome & Thank you for choosing me to deliver your care. I understand this process can seem intimidating and hope to make it as smooth as possible for you.
The following Forms are necessary to establish you as a client and to help me address your concerns. Please print, fill them out, and bring them to your initial consultation. If you are unable to download or access the forms online, they can be emailed to you. If you are unable to complete the forms in advance, please arrive 20 minutes early to fill out the paperwork prior to your scheduled appointment.
At your consultation, we will review the information you provide as well as answer any additional questions you may have. Thank you. I look forward to meeting you.
Privacy Practices:
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY.
Downloadable Forms:
- New Client Information Form: The information on this form will provide your doctor with your reasons for seeking treatment, current symptoms, important history and other relevant details helpful for making an accurate diagnosis and comprehensive treatment plan.
- Office Policies & Treatment Guidelines: This form contains information about office policies as well as guidelines for clients
- HIPAA Patient Acknowledgement: Please read the Privacy Practices and sign this form. You can opt to have the policies emailed to you on this form for your reference.
- Release of Information: In order to provide you with the best integrated care possible, it is important for Dr. Yuan to be able to exchange information with your primary care physicians or therapist. Please fill out this form if you have another doctor or therapist, or friend or family member, whom you would like Dr. Yuan to contact to obtain or give information about your diagnosis, treatment, prognosis, etc. You can specify to whom the information should be released, and what type of information can be shared.
- Request to Restrict Protected Health Information: Please review the office Privacy Practices. If you would like to have your information restricted (e.g. from your health plan or certain individuals), please print and complete this form.
