This section of the website contains forms that you should fill out online
and print after they're completed. You can either bring them with you to a therapy
session or fax them in advance to Dr. Mazza at 301-469-7200. You are welcome
to email the forms to your own computer and complete them there, but
you cannot email the completed forms.
Some of the forms such as the "New Client Information Form" should
be completed prior to our first session. You may also print out and review the
Treatment Agreement form and the Confidentiality Agreement,
as you will be asked to sign those at the first session after we discuss any
questions you might have. The Brief Health Information form is a useful
way for you to summarize your health history.
The forms are easy to fill out while you are at your computer. Just move your cursor to a blank space on the form and start typing. Once everything is filled out click on the save icon on the upper left and save it to a location on your computer you can easily find later. Then email me at jmazza@familytherapy.com and attach the saved file. That's all there is to it.
- Authorization
to Release Protected Health Information
- Brief
Health Information Form
- Confidentiality
Agreement
- New Patient
Information Form
- Request
for Confidential Handling of Health Information
- Treatment Agreement and Notice of Policies and Procedures to Protect the Privacy of Patient's Health Information
