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FORMS

In order to save time and make the therapy process a smoother transition, please feel free to fill out the appropriate forms and bring them to your next visit:

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ADULT Initial Evaluation Questionnaire

Financial Policy

Intake Information

HIPPA Consent Form

Privacy Practices and Services Contract

Telebehavioral Health Informed Consent and Credit Card Authorization

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NOTE: In order to read these documents, you must have Adobe Reader installed. To download Adobe Reader for free, click here.

Bernadette Mullins Miller, MSSW

933 N. Mayfair Road, Suite 101 | Wauwatosa, WI 53226

(414) 378-0999 | bmullinsmiller@yahoo.com

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