Professional and Caring Psychological Services

Saint Louis, Missouri



 


Forms

Intake Form
Release Form
HIPAA:
Notice of Privacy Practices
Acknowlegement of Receipt of Privacy Practices


Intake Form
(to be filled out prior to the first appointment)

An intake form is filled out at the first consultation. Feel free to view this form and possibly print it out using your web browser by clicking here:

intake.pdf


Release Form
(to release information to other individuals)

A signed release form is required for Dr. Krapu to release ANY information to a third party such as a previous or current health care provider, school, or lawyer. To see a release form, which can be used for this purpose and printed through your browser, click here:

PDF format (preferred):
ReleaseOfInformationForm.pdf
or

Release Form (html)

All communications are confidential with the following limits (also see Notice of Privacy Practices). You may have signed a waiver of confidentiality with your insurance company which requires me to provide sufficient information to provide a diagnosis and treatment information to gain authorization of care. In addition, there is a "duty to warn" which I must adhere to if I am aware of an imminent danger to yourself or someone else.


Notice of Privacy Practices

Federal regulations requires notice of Dr. Krapu's privacy practices. For Dr. Krapu maintaining a professional level of confidentiality has always been a top priority. This Federal regulation has required certain paperwork in this area. The following link describes these practices.

HIPAA_Notice.pdf
(preferred)
or

HIPAA_PrivacyNotice.htm


Acknowlegement of Receipt of Privacy Practices

Federal regulations requires you to sign an acknowledgement of having received a copy of my privacy practices. The following link provides this form for you to print out, sign and bring to your first (or next) visit

http://www.krapu4.com/psy/PDF/HIPAA_Receipt.pdf (preferred)
or
HIPAA_ReceiptForm.htm



(314) 842-2258
fax on request

Thank you for your interest.