Dr. Tracy Zemansky

Please click on a link below to download the form.

PSYCHOTHERAPY

• Intake

• Office Policies Form

• Consent for Release of Confidential Information Form

• Consent for Use of Email/Text

• Credit Card Authorization

PSYCHOLOGICAL TESTING & ASSESSMENT

• Psychological Assessment Intake Form

• Consent for Testing/Evaluation

• Consent for Release of Confidential Information Form

• Consent for Use of Email/Text

• Credit Card Authorization

• Rights and Responsibilities For Test Takers (Informational Document for Clients to Review)

PACIFIC ASSISTANCE GROUP/ HEALTHCARE PROFESSIONALS

• Healthcare Professional Intake Form

• Participant Contact Information Form

• Statement of Understanding

• Participant Collateral Contact Form

• Consent for Release of Confidential Information Form

• Medication Guidelines (Talbott) for Healthcare Professionals

• Vacation/Absence Request Form

• Consent for Use of Email/Text

• Worksite Monitor Agreement Form

• Credit Card Authorization