Consent
for ServiceWhen you arrive for your first appointment, you will have a discussion regarding the nature of the evaluation and its potential ramifications, the limitations in confidentiality, and your voluntary participation in the assessment. You will be asked to review and sign a number of forms to document this discussion. Because people are often anxious or nervous at the first appointment, there is a tremendous amount of information to assimilate, and you may want to seek your attorney's input regarding these forms, they are provided here for your preview. You may print them and review them, and if you wish, sign them and bring them to the first appointment. If you prefer, you can read and sign them at the first appointment, after discussing any concerns you may have.
The release of information form that allows our office to obtain information from others may be useful for a number of sources of information. You may complete a copy for each person with whom you want Dr. Connell to consult, such as treatment providers or others with specific knowledge of the situation that brings you here.
The forms are:
Consent for Taping Interviews/Consent for Release of Information for
Research
and Training
Consent for Release of Information from Others
Authorizaton to Release
Protected Health Information
Acknowledgment
of Receipt of Notice of Privacy Practices
Request for Accounting of Disclosures
