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Forms

Below are the forms we use at our practice; however, they are to be completed on our portal (as we are paperless). Once you become a client, you will be sent a portal link to complete the forms.

Authorization Form for Release of Clinical Record

Consent to Use and Disclose Health Information

Good Faith Estimate

Good Faith Estimate Acknowledgement

Informed Consent for Telehealth

Notice of Privacy Policies (HIPPA Compliance)

Client Services Agreement

Patient Information Form

Permission to Use CC Form

BECO Building 11140 Rockville Pike, Suites 530 & 550-E Rockville, MD 20852  Tel: 301-881-8818 | Fax: 301-881-8814

Copyright © 2014-2025 Bonnie Zucker & Associates, P.C. All rights reserved. 

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