Mandatory Forms

IMPORTANT: If you're a new client, you MUST PRINT, COMPLETE, & SIGN/DATE the following 13 (12 forms if not a child/adolescent patient) FORMS and bring them to your initial appointment (and at any appointment thereafter as requested):

1. Informed Consent for Treatment
2. Informed Consent for Limits of Confidentiality
3. Statement of Financial Responsibility (1 of 2)
4. Financial Statement for Prior Authorizations & Letters (2 of 2)
5. Cancellation Notice
6.  Developmental History Questionnaire (parents please complete for child/adolescent patient only)
7. Self-Assessment Form
8. HIPAA Notice of Privacy Practices
9. HIPAA Privacy Signature Form
10. HIPAA Privacy Request Form
11. INFORMED CONSENT FOR TELEPSYCHIATRY
12. IN-PERSON APPOINTMENTS INFORMED CONSENT DUE TO COVID
13. IN-PERSON APPOINTMENT WAIVER DUE TO COVID

**INFORMATION FOR PATIENTS: Duty to Warn NJ Law (Updated by NJ governor in June 2018)

This is so I can give you the best treatment that you certainly deserve!

Thank You,
Dr. Hraniotis, M.D.