Forms

Before your initial appointment:

Consent Form – please print, sign and bring with you.

HIPPA Form – please read and sign at end of consent form to acknowledge.

Intake Form – please print, sign and bring with you.

Forms as Needed:

Release of Information Form – please fill out and bring with you if you have other parties with whom you wish me to communicate to benefit your treatment (e.g. previous therapist, psychiatrist or other physician)

Credit Card permission form – please fill out and bring with you if you wish me to keep your credit card information on file.

Medicare Patient Form

Telehealth Policies/Consent

Collateral Consent Form

These are the most recent forms. If you began treatment with Dr. Hopper before October 2019, please contact her for older versions.

Please see FAQ for information about email directions.