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Frances E. Reinker, Ph.D. Licensed Clinical Psychologist
Frances E. Reinker, Ph.D.Licensed Clinical Psychologist

Client Forms

New clients will need to complete three forms and read two documents before therapy can begin. To make the process as smooth and efficient as possible, the most important documents are provided as downloads right here on the website. Each document can be downloaded separately. Forms are also available at the practice; however, filling them out in advance saves time.

 

Most clients will have a total of three one page forms to bring to the first session.   If you will using telehealth for your sessions you will also need to print out, sign and return the Informed Consent for Telehealth Services form near the bottom of this list.  There is also a "tip sheet" for clients who will be using telehealth services with suggestions for making sure your technnology is ready and in good working order.  If you are unsure which forms to fill out, feel free to contact me. 

Client Registration
This form asks for basic demographic information and information about your health insurance.
Client Registration 2020.pdf
Adobe Acrobat document [92.2 KB]
Client Information
This form asks for referral information, medications, and health concerns.
Client Information Form 2020.pdf
Adobe Acrobat document [277.0 KB]
Virginia Notice Form
This document explains how your private health information may be disclosed and your rights with respect to disclosure. Please read this carefully.
VA Notice Form - 2020.pdf
Adobe Acrobat document [297.7 KB]
Psychotherapist - Patient Agreement Form
This document provides information about the therapy process and the roles of both the therapist and client. Please read this carefully.
VA Psychotherapist - Patient Agreement F[...]
Adobe Acrobat document [138.7 KB]
Signature Page
This form indicates that you have received and read both the Virginia Notice Form and the Psychotherapist-Patient Agreement, and agree to abide by their provisions.
Client Signature Page 2020.pdf
Adobe Acrobat document [5.8 KB]
Informed Consent For Teleheath Services
This form is an Informed Consent form for telehealth services which must be completed and signed by anyone using telehealth services.
Informed Consent - Telehealth.pdf
Adobe Acrobat document [76.2 KB]
Tips For Using Telehealth Technology
This is a tip sheet to help clients who are using telehealth services.
Technology Tips.pdf
Adobe Acrobat document [71.9 KB]

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Location

Frances E. Reinker, Ph.D.

 

Williamsburg Office Park

1317 Jamestown Road

Suite 102

Williamsburg, Virginia           23185

 

Phone:  757-220-2700

 

Email:  fereinker@cox.net

Office Hours

Monday through Thursday

9AM - 5PM

 

Client Forms

Are you a new client? Save time and reduce the amount of paperwork you have to fill out at your first visit. Go to client forms and download the PDF forms you need to get started.

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© Frances E. Reinker, Ph.D.