Documents

Client Service Forms 

The following link takes you to my client portal. The portal links to all the forms you may need to complete. Register your name and create a password. You will find forms required by insurance and/or regulations. You may complete or attest to these on-line or await until your office visit. I am happy to address any questions. 

Dr van den Daele’s Client Portal 

Welcome to my practice.  This document contains important information about my professional services and business policies that relate to assessment and psychotherapy.

Dr Van Den Daele’s Client Service Contract

This document describes my practice when confined to consultation.

Consultant Contract

This document is provided by the Department of Health and Human Services and applies to all health providers.

HIPPA BOOKLET FOR HEALTH CARE PROVIDERS

This document for parents or guardians of a child referred for assessment or therapy.

Child history form