Howard Lindemann, lcsw
512 420 9611 firstname.lastname@example.org
5828 Balcones Drive, Suite 103 near Loop 1 (MoPac) and RM 2222/Northland Drive
copyright © 2017 Good Changes Psychotherapy
Although I try to keep paperwork to a minimum, approximately 15 minutes is needed to supply the information required for our first meeting.
The forms listed below may be viewed, printed and completed prior to our first session. Upon completion you may fax (512 420 9599), mail (to Howard Lindemann, lcsw, 5828 Balcones Drive, Suite 103, Austin, TX 78731-
I maintain strict security measures regarding my electronic and manual records. However, email has inherent security flaws and I ask that you not transmit confidential information via email.
The Privacy Policies that I follow are dictated by state and Federal law including the Health Insurance Portability and Accountability Act (HIPAA) and are described in the Notice of Privacy Policies. You may wish to view the three page document online or download and print it for your records.
The Receipt and Acknowledgement of Notice of Privacy Policies form may be accessed here. It indicates that you are aware of your Privacy Rights. This form is to be completed prior to or during our first meeting.
The Confidential Questionnaire is used to obtain, from you, general demographic and insurance information. Additionally it will gather some of your history and a description your current difficulties and needs. The questionnaire may require 10 -
If you will be using insurance, please bring your health insurance card.
Access the Forms Here
Sunset near Taylor, Texas