Alec Baker, Psy.D.

Forms

This is the ‘Forms’ page where you can find all of the paperwork necessary to get started.  Please print out and complete the ‘Disclosure & Confidentiality Agreement’ form and bring it with you to your first appointment.  Also, please review the ‘HIPAA Notice’ before your first appointment.  If you plan to pay by credit card, please print out and complete the ‘Credit Card Authorization’ form and bring it with you along with your ‘Disclosure & Confidentiality Agreement’ to your first appointment.

 

Child & Family Confidentiality & Disclosure Form

Required form communicating your rights as a client.

Adult-Individual Confidentiality & Disclosure Form

Required form communicating your rights as a client.

Psychological Assessment Disclosure & Confidentiality

Required form communicating your rights as a client.

Adult Life History & Background Questionnaire

Help us get started by providing some details about your history and background.

Credit Card Release

Fill this form out so I can process your billing electronically with your credit card.

Consent to Release Information

Fill this form out so that I can speak with others about your case.

HIPAA Notice

Required form that discusses your rights under HIPAA.