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Dr. Stephanie Smith

Psychologist

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Forms

NEW PATIENT FORMS

**Please read through all pages. Please print forms that are **starred**

First Appointment Information

**New Patient Information Form**

**Credit Card Authorization Form**

**Informed Consent Form**

**Good Faith Estimate Signature Page**

HIPAA Privacy/Confidentiality Information

Good Faith Estimate Information

EXISTING PATIENT FORMS

Release of Information

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