Client Forms

Client Forms


If you are a new client, please download and print the Client Info Form, Consent for Treatment, Electronic Media Policy, and Electronic Communication Consent Form. Fill them out, sign them, and bring them to our first meeting. The map, e-payment disclosure, and email & text risk questionnaire are for your information and you may keep them.

If you’d prefer to send them to me electronically, upload them to my encrypted Dropbox at this link.  

 


drsaddison@gmail.com

510-599-5467

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By submitting this form via this web portal, you acknowledge and accept the risks of communicating your health information via this unencrypted email and electronic messaging and wish to continue despite those risks. By clicking "Yes, I want to submit this form" you agree to hold Brighter Vision harmless for unauthorized use, disclosure, or access of your protected health information sent via this electronic means.