Client Forms

Treatment Authorization

Treatment Authorization

Treatment Authorization

Please complete the Authorization form prior to your first visit.​ 

Our HIPAA Philosophy

Treatment Authorization

Treatment Authorization

In order to establish a therapeutic alliance, it is essential that the Therapeutic Relationship is understood to be sacrosanct.  What is revealed in therapy will NEVER be disclosed without written consent.  The relationship is based upon the Biomedical Ethics of respect for Autonomy, Beneficence, Non-Maleficence, and Justice.

Release of Information

Treatment Authorization

Release of Information

You will be instructed to complete the Release forms as needed.

After completion

Request for Information

Release of Information

All forms will automatically be sent to your therapist and a copy sent to your email.

You do not need to "print" them.

If you have any questions, 

please email Associates@ccanda.org

Privacy Notice

Request for Information

Request for Information

Please Read the following Privacy Notice
(You are welcome to save a copy for your records) 

Request for Information

Request for Information

Request for Information

If you would like to request your records from anyone.  You my complete the Request for Information below to "Authorize" the release of your information to CCandA, LLC.