Forms
In order to save valuable time, we've added these forms to our web page so that you can fill them out in advance.
DR LEDESMA'S FORMS:
CtDataSheet2.doc (1 page)
Outpatient_Services_Contract_-_Jones.doc (read & sign)
Notice_of_Privacy_Policies.doc (read & sign)
Personal_History_Questionnaire.doc (generally takes 5-10 minutes)
Psychotherapy Assessment Checklist (For adults only - generally takes 30-40 minutes to complete)
** PLEASE NOTE THAT COPAYS ARE DUE AT THE TIME OF SERVICE & THERE IS A $5 CHARGE IF WE HAVE TO BILL FOR COPAYS.
LESA SWANSON'S FORMS:
CtDataSheet2.doc (1 page)
Outpatient_Services_Contract_-_Swanson.doc (read & sign)
Notice_of_Privacy_Policies.doc (read and sign)
Personal_History_Questionnaire.doc (generally takes 5-10 minutes)
Psychotherapy Assessment Checklist (For adults only - generally takes 30-40 minutes to complete)
** PLEASE NOTE THAT COPAYS ARE DUE AT THE TIME OF SERVICE & THERE IS A $5 CHARGE IF WE HAVE TO BILL FOR COPAYS.
