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.
- Client Information Form
- Client Rights
- Medical History
- Insurance Coverage – not required if paying out of pocket
- Service Agreement
- Electronic Consent
- HIPAA Receipt & Acknowledgement
- HIPAA Policy – for your records
Download a .zip folder of all forms: