Thelma Hurley

Forms

Adult Forms
PHQ9
 
Teletherapy Forms
hipaa guidelines

Before your first visit, you’ll need

Payment Arrangements

Please be aware charges will apply for requests that go beyond the scheduled session time. Telephone calls and written communications will be charged on a prorated basis.

PLEASE CALL MY BILLING SERVICE AT 1-800-789-5761 x0 and ask for someone to verify your benefits. This call is REQUIRED BEFORE our first appointment if you are using insurance for your visit.

Forms for your first appointment

Please download, print, complete and sign the forms above before your first appointment. Forms should not be printed two-sided. We will review the new patient forms together during your first visit.

Please print the forms on single sided pages only.​