Patient Documents

Download Intake Form New Patient / Inname Vorm: Nuwe pasient
This document is to be completed by all new patients. It includes the New Patient Intake Form, the Consent to Disclosure of Information and Fees Agreement and the PHQ-9 questionnaire

Download Online Therapy Agreement
If you are opting for online therapy, this agreement will detail the terms of your online sessions.

Download PAIA Manual
This manual was prepared in accordance with section 51 of the Promotion of Access to Information Act, 2000 and to address requirements of the Protection of Personal Information Act, 2013.

Download PAIA Form 2
Request for Access to Record (Regulation 7)

Download PAIA Form 3
Outcome of request and of fees payable (Regulation 8)

Instructions:

1. Download the applicable form by clicking on the links above.
2. Complete all sections.
3. Once finished, please email the completed form/s back to me.

Your cooperation is greatly appreciated and will help me provide you with the best possible care.