Forms to Complete
Intake Forms
Your initial intake form will be available in the Jituzu client portal after you are sent an invite to the portal and set up your user identification and password.
Your initial intake form will be available in the Jituzu client portal after you are sent an invite to the portal and set up your user identification and password.
Professional Disclosure and Notice of Privacy Practices
These documents summarize my training, credentials, and cancellation policies. It reviews the limits of confidentiality and provide details regarding your privacy rights in keeping with the Health Insurance Portability and Accountability Act. These documents will need to be printed and signed before the start of our first session. You can scan the signed documents and upload them into your Jituzu client portal, or bring them to your first session.
These documents summarize my training, credentials, and cancellation policies. It reviews the limits of confidentiality and provide details regarding your privacy rights in keeping with the Health Insurance Portability and Accountability Act. These documents will need to be printed and signed before the start of our first session. You can scan the signed documents and upload them into your Jituzu client portal, or bring them to your first session.
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Print and sign
Forms for initial appointment Notice of privacy practices and Professional Disclosure |
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