Please complete all of the applicable forms below prior to your first appointment.

You are welcome to submit these forms in any way that feels comfortable to you or if you are
scheduled for an in-person appointment, you may choose to bring a printed copy with you to the initial appointment.

Intake Form

Informed Consent

Telehealth Consent

Biofeedback Consent (if applicable)

Insurance Information (if applicable)

or

Good Faith Estimate (if applicable)

HIPAA

Fountain Square Mall Bloomington, IN 47404

Contact:

Christy Duffy, PhD, HSPP
812-269-2181 drchristyduffy@gmail.com

Locations: