Forms

FOR CLIENTS & POTENTIAL CLIENTS:

Authorization for Request and Disclosure of Client Information – UNCG Psychology Clinic – Release Form

Client Bill of Rights – Client Rights Brochure

UNCG Psychology Clinic Notice of Privacy Practices – Notice of Privacy Practices

Notice for Right to Receive a Good Faith Estimate of Expected Charges – Notice of Good Faith Estimate

FOR REFERRING AGENCY USE ONLY:

Please find the UNCG Psychology Clinic referral form and letter explaining its use below: