Stephens Psychological Services LLC
Carol Stephens Psy.D., LP, CBSM

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       Before your first appointment, please fill out the following two (2) forms and bring them to your appointment. These include the Client Registration Form, and the
       HIPAA Receipt Form. If there is information you would like for me to share with others please sign the Consent for Release of Info Form.

       I also will need a copy of both sides of your insurance card.

       Please review the Client Rights and HIPAA Brochure about privacy of medical records. We are required by law to obtain your signature indicating that you were offered
       this information, not that you read or agreed with it.

Client Registration Form    HIPPA Receipt Form    Consent for Release of Info Form    Client Rights    HIPPA Brochure

Carol Stephens Minneapolis MN
© 2012 - Carol Stephens Psy.D.,LP