Forms — Laurisa Rogers, LCSW

Patient Health Data Form

Registration Form

HIPAA Consent Form

Symptom Form - Adult

Symptom Form - Ages 6-17 Parent/Guardian

Symptom Form - Ages 11-17 Self-Report

Child Attachment Checklist

EMDR Consent Form

Telemental Health Consent Form

Please click on a form to download.

Informed Consent Form

Policies and Practices Form