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Martha Ireland, PhD, RN, CS

Eating Disorder Specialist & Clinical Trauma Professional

Eating Disorder Specialist & Clinical Trauma Professional

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Home » Forms

Forms


On this page you can access our forms:

  1. Client Intake Form
  2. Client Consent Form
  3. Notice of Privacy Practices
  4. Notice of Privacy Practices Receipt and Acknowledgement of Notice
  5. Adult Information Form
  6. Adolescent Information Form
  7. Authorization for Disclosure of Protected Health Information
  8. No Harm Contract
  9. Informed Consent for Online Therapy
  10. ADE Permission to Contact Form


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