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FORMS

Forms

Please download, read and fill out the relevant PDF forms below and bring them to your next appointment with your therapist.

  • You may ignore the insurance coverage form if you are paying out of pocket for your therapy.
  • There is no need to print the HIPAA Policy unless you wish to save a copy for your records. Only the HIPAA Receipt and Acknowledgement form need be printed, signed and returned with the other required forms.
  • We will provide you with a brochure outlining your rights as a client at Harmonia.
  1. Client Information Form
  2. Client Rights
  3. Medical History
  4. Insurance Coverage – not required if paying out of pocket
  5. Service Agreement
  6. Electronic Consent
  7. HIPAA Receipt & Acknowledgement
  8. HIPAA Policy – for your records

Download a .zip folder of all forms:

  1. All Client Forms