For our clients convenience we have made some of our forms available here
 

Patient Registration/HIPAA Policy

Some clients prefer to review and/or complete their intake paperwork before their first appointment with Dr. Rouanzoin.  The patient registration along with the office HIPAA policies are available to download and print here in pdf format.  If you have questions about any of the items please leave them incomplete and bring them to your first session.  Additionally, please note that Dr. Rouanzoin only bills insurance through prior arrangement, and is happy to discuss your billing arrangement with you prior to your appointment or at your first session.

Download Patient Registration form

Credit Card Authorization

If you would like to pay your bill by credit card on a one time or ongoing basis, please fill out this form and mail it in or bring it in to your next appointment.  Please do not FAX this form as it is best to have a "live" signature.

Download Credit Card Authorization form

Consultation Agreement

If you are seeing Dr. Rouanzoin for EMDR consultation, please fill out the information on this sheet and mail or bring it to your appointment with him.

Download Consultation Agreement