TRACY SAFF DOW Psy.D.
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  • About
  • Services
  • New Client Info
  • FAQ
  • Contact

New Client Information

Are you ready to remove roadblocks?

You are in the right place. Please download, review, fill out and return the following new client information.

Patient Information Sheet

Patient Information Sheet

Outpatient Services Contract

Outpatient Services Contract

Release of Information

Release of Information

HIPAA Privacy Notice

HIPAA Privacy Notice

HIPAA Signature Form

HIPAA Signature Form

Credit Card Agreement

Credit Card Agreement
713.444.1372 | 6750 West Loop South, Suite 1000, Bellaire, Texas 77401 | Texas License #32425
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