DEBORAH KLINGER, LMFT, CEDS-S Psychotherapy and Yoga Therapy
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If you have scheduled an initial appointment, please download, read, print and fill out/sign the following forms as indicated, and bring them with you.
     1. For individual, couples/relationship or family therapy: New Client Background Information Form and Office Policies
        Sheet:

        Therapy Intake Forms
        
For group therapy: New Group Member Background Information Form and Office Policies Sheet:
        Group Therapy Intake Forms

 

    2.  For ALL new clients:
        
HIPAA paperwork:  The Health Insurance Portability and Accountability Act (HIPAA) requires that health care providers                 notify patients of their policies affecting confidential patient/client information.
         Please download a copy of our HIPAA notice for your records:
           HIPAA Notice       
         Please print out and sign the Informed Consent form and bring it to your first session:   
         
HIPAA Informed Consent


    For more information about HIPAA, see http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html
          Due to COVID-19, all sessions are currently conducted via video or telephone. Please sign the Telemental Health                     Informed Consent form and send me the signature page:        
          Telehealth Informed Consent form
       
     3. If you will be using insurance:
         If you have an insurance plan OTHER than the Duke University student plan, use these questions to call your                                insurance company and ask about your plan's "out-of-network outpatient mental health benefits:"
       Insurance Benefit Information

         And for all insurance plans-- the Duke student plan, and those of you who are using out-of-network benefits and would               like
me to file the claims (if you prefer to do the filing yourself, please ignore this):
        New Client Insurance Policy Information

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