CLIENT FORMS

Please download the forms by clicking on the pdf button, fill them out and email them back. 

Your privacy is our primary concern. 

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Email: susan@susanraphael.ca

1. Consent to Disclose Personal Health Information 

Consent to Disclose Personal Health Info

2. Confidential Patient Information Form 

Consent to Disclose Personal Health Info

3. Consent to Services Form

 

Consent to Disclose Personal Health Info

DISCLAIMER

The information on this page or site is for informational and educational purposes only. It is not a substitute for medical or mental health care.

 

Following this page does not constitute a therapeutic relationship. If you are

a client and comment on my page it may impact your confidentiality.

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Please remember to protect your privacy.

LET'S CONNECT

Email: susan@susanraphael.ca

Phone/Text: 416-271-1117

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