Forms
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.
Therapy intake forms:
Intake Form
Informed Consent
Telehealth Consent
HIPAA
Biofeedback intake forms:
HIPAA
Insurance/Payment forms:
Insurance Information (if applicable)
or
Good Faith Estimate (if applicable)
Fountain Square Mall Bloomington, IN 47404
Contact:
Christy Duffy, PhD, HSPP
812-269-2181 drchristyduffy@gmail.com
Location: