Lauren B. Yerkes, Psy.D.
Licensed Clinical Psychologist
Please print, sign, and return prior to first telehealth appointment.
This form is necessary only if you would like to grant me permission to release confidential information to another person, provider, or agency.
Please print and complete one form for each person/agency if you would like to grant this permission.
This form is for current clients only who need to update their information. Please print, sign, and bring to session.