DrNierenberg.com

Biofeedback - Applied Psychophysiology - Health Psychology - Pain Management

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About Dr. Nierenberg

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Forms

At the Evergreen Behavioral Health website you will find the basic forms you will need to begin our work together. The initial necessary forms are available for download.  I know there is a lot of paperwork and I wish there were a way around it, but there just isn't at this point. Some forms are required by law, statute, or ethics (such as the HIPAA Notice of Privacy Practices) and others are there to help us make the very best use of our time together (such as the Adult Client Information Form).

For our first meeting together you will want to complete at least the Adult Client Information form, the Insurance Verification Form, and the Notice of Privacy Practices. If you are planning on using insurance, you will need to complete the Release of Information form that allows me to talk with another provider(s) working with you on this condition for Coordination of Care purposes, If you have a family member of friend with whom you would like me to be able to speak, you will want to also fill out a Release of Information form for each individual. To download these forms, go to
evergreenbehavioralhealth.com.


When you come in you will be given a laminated copy of Evergreen Behavioral Health's Disclosure of Clinic Policies and Procedures and Informed Consent for Services Treatment as well as a HIPAA Notice of Privacy Practices.  You may review these ahead of time if you arrive early for your appointment but you will not sign them until we speak at your first appointment, so that you can have the opportunity to ask any questions or express any concerns.


If you have any difficulty downloading any of the forms please contact our patient services staff at 360.450.0140 for copies of the forms you need.

For some specific conditions, such as IBS, Insomnia, or Headaches, I may have an additional form to help me more thoroughly understand your experience with that condition. If indicated, I will give you that form at our initial session.

I look forward to meeting you.  Be well.

D. Nierenberg, Ph.D.	Copyright June, 2007     Rev. Dec 2008