NEW CLIENT FORMS

Please review & complete prior to your first appointment.

HIPPA/Notice of Privacy & Practice (Please note, you may choose not to print this form but rather just review it).

Release of Information Form (Complete if you would like us to obtain prior records OR share information with others such as your primary care doctor, psychiatrist, or school)

RELEASE/EXCHANGE OF INFORMATION

Release of Information Form (Send or Receive Records)

  • Release to other healthcare providers is free. Information regarding charges for records for non-healthcare related use is available at this link.

TELEHEALTH

To Enter The Online Waiting Room for Dr. Versland CLICK HERE (This works best with a computer (PC/Mac) and requires access to both your camera and microphone).

To Enter The Online Waiting Room for Dr. Siddiqui CLICK HERE (This works best with a computer (PC/Mac) and requires access to both your camera and microphone).

OTHER

Insights Psychology, LLC Forms (Complete only if advised by Dr. Siddiqui)

Group Consent Form