All new clients can read/download/print the following forms to fill out prior to your initial appointment with Dr. Blue. You may then email them back to Dr. Blue at Jim.Blue@Charter.net, or simply bring them with you on the day of your appointment.
1.) The HIPAA Notice and the Treatment Plan are for your information, and are yours to read and keep. You may print them or simply read them online.
HIPAA Notice. Dr Jim Blue 2018
Treatment Agreement. Dr Jim Blue 2018
2.) The next two documents are signature pages, acknowledging you have read the HIPAA Notice and the Treatment Agreement. These two forms need to be printed, signed, and returned to Dr. Blue to keep on file.
Client Profile. Dr Jim Blue 2018
HIPAA Acknowledgment of Receipt Notice – Dr. Blue Feb 2018
3.) The next form is for detailing your current concerns and a bit of your life history.
History & Assessment – (Adult)
4.) If you will be paying by credit card, please print out and complete the form below and return it to Dr. Blue. Your card will be kept on file for future payments, and can be discontinued by you at any time.