Paperwork for Services with Terri Delaney, LICSW

 

Therapy Agreement (print and read)

Therapy Agreement (PDF)

Includes Client Bill of Rights, Confidentiality Agreement, HIPAA Notice form and billing information.

Print, sign and submit to Terri Delaney

Signature page (PDF)
Please complete and sign PDF and send in

Telehealth Agreement (PDF)
Please complete and sign PDF and send in

Somatic Experiencing Informed Consent (PDF)
Please complete and sign PDF and send in