SAMPLE FORM LETTER RESPONSES TO SUBPOENA
Use this form letter when responding to a subpoena. The responses are grouped by type of response - from invalid subpoenas, to assertion of privilege, to objections, to improper requests, to compliance.
INFORMED CONSENT FORM
Use this form when the legal system requests a copy of psychotherapy records. Review it with the patient to ensure that they have an adequate understanding of the risks and benefits of whatever choices they make.
ATTORNEY-PSYCHOLOGIST STATEMENT OF UNDERSTANDING
Our standard contract when attorneys hire us as a forensic psychologist / expert witness.
FLORIDA HIPAA NOTICE OF PRIVACY PROTECTIONS (NOPP)
Patients may download this document if they have questions about their privacy rights.
DISCLOSE RECORDS TO DR. BORKOSKY (from another provider)
Use this form to obtain (healthcare) records from collateral sources, and/or when someone wants to send me records from another provider.
DISCLOSE RECORDS FROM DR. BORKOSKY (to another provider)
Use this form if you want Dr. Borkosky to disclose records to a third party.
PATIENT INTAKE FORM
Everything you always wanted to know about patients, but were afraid to ask!
Dr. Bruce Borkosky, Psy.D.. PA
305 Pine Tree Dr,
Dothan AL 36303
Phone: (863) 386-0276
toll free (800) 919-9008
Fax: (863) 204-4679
Email: drborkosky at gmail dot com
Dr. Borkosky's practice is limited to telehealth at the present time.