The following forms are available for download.


If you wish, you may download clinic registration forms in advance of your first appointment. Complete them at home, and bring them with you to your first meeting. Forms marked with an asterisk (*) must be completed for the first appointment. You may also choose to wait until your appointment to complete the necessary forms in our office. If that is the case, please try to come a few minutes early to your scheduled appointment so that you have time to complete the paperwork before your meeting with our staff.

*Clinic Registration Form: This form contains basic demographic and insurance information. The form also tells us why you are visiting Clinical Psychology Associates and has information about important office policies about which you should be aware.

*Notice of Privacy Practices: This is the official HIPAA notice for our agency, and it tells you how your confidential information may be used.

*Acknowledgement of Receipt of Privacy Practices: Your signature on this form shows that we gave you the Notice of Privacy Practices as required.

*Complaint and Appeal Procedures: Clinical Psychology Associates attempts to resolve client concerns or complaints in a timely manner. Informal complaint resolution procedures are available to you by simply contacting our Office Manager, Christine Mamerow, at 262-534-7777. If you feel that informal procedures are not effective, or If you which to make a formal complaint about our clinic or the services provided to you, you may do so with one of the agencies on this form.

*Client Complaint Form: If you wish to file a complaint with us concerning our services, you may do so using this form.

Authorization to Disclose Information: This form is completed whenever you wish Clinical Psychology Associates to share your confidential information with someone else. It can also be used when asking another person or agency to send your confidential records to Clinical Psychology Associates.

Notice of Informed Consent: