Associated Psychologists, PLC
Please see below the following forms which may be downloaded:

1. Release of Information: to be used to give a family member access to your information as part of
treatment, for billing purposes, or to request that information from your records be sent to another provider.
Please complete all sections of this form.

RELEASE OF INFORMATION

2. Consent for "Telehealth/Online Therapy" Services

CONSENT FOR ONLINE TELETHERAPY SERVICES


Once completed, either form can be Faxed back to 586/776-3369.