The following forms are available for download
*Notice of Privacy Practices: This is the official HIPAA notice for our agency, and it tells you how your confidential information may be used.
*Complaint and Appeal Procedures: Clinical Psychology Associates, LLC 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 262-763-9191. 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, LLC 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, LLC.