Welcome to my practice!
If you are interested in psychotherapy services, please give me a call. Once we have spoken and you have decided to proceed with the intake process, you will need to complete an (1) Intake Form,(2) Psychotherapist – Patient Service Agreement and the (3) Virginia Notice Form.
You may print out these forms, fill them in manually, and mail them to the address below. Or if you prefer, you can complete these forms electronically through a patient portal. If you wish to set up a portal account, I can provide you with instructions when we speak.
I provide telepsychology services. To comply with the professional standard of care for telepsychology, I have included additional documents which may also be completed manually or electronically. These forms are the (4) Informed Consent document which contains important information on using the phone or the internet, an (5) Authorization for Emergency Contact document, which asks you to provide the name and telephone number of an individual in your location who I can contact in the event of a crisis, an (6) Electronic Communication Policy to assure the security and confidentiality of your treatment in accord with ethics and the law (this form is for your information only), a (7) Notice of your rights to receive a Good Faith Estimate of fees (this form is for your information only), and a (8) Good Faith Estimate document for you to sign and return along with the other forms to the address below.
Norma Caruso, Psy.D.
P.O. Box 8681
Richmond, Virginia 23226
If you would like to discuss these forms or if you have questions, please call me at 804-272-
7287.
1. Intake Form
2. Psychotherapist – Patient Service Agreement
3. Virginia Notice Form
4. Informed Consent
5. Authorization for Emergency Contact
6. Electronic Policy
7. Good Faith Estimate Notice
8. Good Faith Estimate