PLEASE NOTE:

If you have questions about the First Session Forms I will be happy to discuss them with you during our initial appointment.

• Consent for Services (required)

Please provide information and signatures of both parents/legal guardians if your child is under 18 years old.

• Telepsychology Informed Consent (required)

Please provide information and signatures .

• HIPAA Notice and Receipt (required)

Please provide information and signatures on separate "receipts" for each person that will be meeting with Dr. Stroup.

• Client Contact (required)

Please complete separate forms for each person that will be meeting with Dr. Stroup.

• Adult Information (required for clients 18 years old or older)

Please complete if you are a client over 18 years old.

• Child Information (required for clients under age 18)

Please complete for any child client under 18 years old.

• Payment Agreement (required)

Please provide information and signatures of both parents/legal guardians if your child is under 18 years old.

• Privileged Communications Agreement (required for clients under age 18)

Please provide information and signature of both parents or legal guardians.

• Credit Card Authorization (optional)

Authorization for credit card charges for professional services using Squareup.

• Release of Information (optional)

Authorization for release of information to specified parties (i.e physicians, spouses, etc.)