Samantha Wakach Forms

Client Services Agreement

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Telemedicine Informed Consent Form

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Authorization to Exchange and Release Confidential Information Form

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Health Insurance Portability and Accountability Act (HIPAA)

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New Client Intake Questionnaire

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Minor Child Information Sheet

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Credit Card Authorization

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“No Secrets” Policy for Family Therapy and Couple Therapy

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“Disclosure Statement (State of Washington Clients Only)

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Consent For Teletherapy (State of Washington Clients Only)

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