Documents

These documents are made available to you for viewing purposes ONLY!

If you plan to schedule and attend sessions, these documents must be completed in their official format through PatientPortal.

If you desire to borrow any information found on these documents, please ask us first as a professional courtesy, Thank You.

Informed Consent for Psychotherapy

Covering nearly all avenues of the therapeutic process: our fees, payment processing, disclosure of Protected Health Information (PHI), Supervisors' contact information (if your Provider is a Resident or Supervisee), and much more will be found in this document.

The Informed Consent is posted to the right; feel free to read the document and let us know if you have any questions.

InformedConsent.pdf
IntakeInformation.pdf

Intake Questionare

These are questions asked at most any therapy office. They are utilized as a starting point for the Provider to better understand the focus of treatment, but are not used to provide a bias or preemptive view of the individual in any way.

Several individuals have come in with concerns of this document being used against them or painting an unflattering picture of them; we stress this document is not used in our clinical documentation nor is it made available to any person requesting documentation as it is a self completed form and a Clinician did not complete this assessment from a clinical theoretical basis.

Feel free to read through them in the document posted on the left for being prepared to complete the form in our PatientPortal or for bettering your understanding; let us know if you have any questions.

Tele-Health Screening

We live in the age of technology, and that extends to counseling services. TWMH has specialized training to render services via asynchronous audio/video telecommunication. The HIPAA compliant service we utilize, Doxy.Me, provides a simple mimicry of the in-person counseling experience, and is simple to utilize. Please see the Tele-Health page for instructions.

To the right is an example of the screening form we ask to be completed at the beginning of services to determine if you are an ideal candidate to gain access to this service.

Tele-HealthScreening.pdf
PrivacyPractice.pdf

Notice of Privacy Practices

"Your health care provider and health plan must give you a notice which tells you how they may use and share your health information. It must also include your health privacy rights. In most cases, you should receive the notice on your first visit to a provider or in the mail from your health plan. You can also ask for a copy at any time."

- HHS.gov -

Posted to the left, is TWMH's Privacy Practices with descriptions of the above requested by our governing bodies for professional health care providers.

Business Associate Agreements (BAA)

Under the U.S. Health Insurance Portability and Accountability Act of 1996, a HIPAA BAA is a contract between a HIPAA-covered entity and a HIPAA business associate (BA). The contract protects personal health information (PHI) in accordance with HIPAA guidelines.

These are our BAAs, posted to the right, with Doxy.Me, Google, and TheraNest; others will be added as we join with other business partnerships. Feel free to read them over and let us know if you have any questions.

BAAs.pdf