Professional Psychological Associates
3745 Shawnee Road, Suite 105, Lima, OH 45806 419-999-2024
Forms you will need...
On this page you will find the forms to be completed before your first session
and thereafter depending on your needs.
Each form will be titled and instructions provided for completion.
PPA Intake Form - To be completed before your first session and brought to your first session.
PPA Questionnaire - To be completed before your first session and brought to your first session.
PPA Acknowledgement of HIPAA - To be completed before your first session and brought to your first session.
PPA Consent to use Email or text - To be completed before your first session and brought to your first session.
PPA Welcome Brochure - To be read before your first session.
PPA Notice of Policy & Practices to Protect the Privacy of Your Personal Health Information (PHI)
To be read before your first session.
PPA Website Privacy Policy- To be read before your first session.
PPA Social Media Policy - To be read before your first session.
PPA Release of Information Form - To be completed when you need your therapist to speak to another person,
for example, your physician or a family member.
PPA Consent to Treat a Minor Form - To be read an completed when a child under 18 years of age will engage in therapy.
PPA Informed Consent for In-Person Services During COVID-19 Public Health Crisis Form - To be read and completed by clients engaging in In-Person sessions dated June 1, 2020 forward. PLEASE PRINT & BRING TO YOUR THERAPIST.
PPA Telehealth Crisis & Emergency Contact & Release Form - To be read and completed when engaging in telehealth.
PPA Informed Consent for Telehealth Form - To be read and completed when engaging in telehealth.