New Patient Forms
Consent to Treatment |
Consent to Release Information
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This form outlines risks and benefits of engaging in psychological treatment and your rights as a patient
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This form authorizes Integritas Psychological Services, Inc. to release your confidential and protected health information.
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Consent to Assessment
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Payment Contract
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This form outlines risks of treatment, your rights, reception of information, our ethical obligations, and patient responsibilities
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This form outlines your rights and responsibilities with regard to payment for services received at Integritas Psychological Services, Inc. It includes a Federal Truth in Lending Statement and constitutes a contract for services
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Privacy Policy
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Rights & Responsibilities
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This form describes the confidentiality of your medical records, how the information is used, your rights, and how you may obtain this information
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This form describes your rights and the grievance process if you believe your rights have been violated.
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Policies & Procedures
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Electronic Communication Policies
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This form lists the policies and procedures of Integritas Psychological Services, Inc. (IPS). If you have questions or concerns with any of the policies and procedures described in this document, please contact IPS.
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This form clarifies the use of electronic communication during treatment.
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Standard Notice & Consent Documents
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This form lists protections from unexpected medical bills and policies for out-of-network care.
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| Standard-Notice-&-Consent.pdf |