THE ANXIETY AND OCD TREATMENT CENTER OF ANN ARBOR
  • Home
  • Our Providers
    • Amy Plavnick, LMSW
    • Dylan Broggio, LMSW
    • Debra Levine, PhD, LP
    • Kiley Hierl, PhD, LP
    • Fred Upton, PhD, LP
    • Lisa O'Donnell, PhD, LMSW
    • Laura M. Lokers, LMSW >
      • Presentations
      • Publications
    • JoAnne Shipman, LMSW
    • Sara Greschuk, LMSW
    • Gim Toh, PhD, LP
    • Katie Tucker, LMSW
    • Emily Fisher, LMSW
    • Christina LaRosa, MD
    • Kendall Gaspari, LLMSW
  • What we treat
    • Panic Disorder
    • Social Anxiety Disorder
    • Generalized Anxiety Disorder
    • Specific Phobias
    • Post Traumatic Stress Disorder
    • Illness Anxiety Disorder
    • Obsessive Compulsive Disorder
    • Trichotillomania
    • Hoarding Disorder
    • Body Dysmorphic Disorder
  • Services
  • New Clients
  • Patient Forms
  • Contact Us
    • Patient Portal
  • FAQ
  • Links
  • Classes
  • For Other Providers

Release of Information Forms

If you have people you want to give us permission to communicate with (your PCP, psychiatrist, another therapist, your employer/school, etc) please complete the ROI forms and bring those to your appointment.
Release of Information for all persons/organizations except your Primary Care Physician (PCP)
Release of Information for your Primary Care Physician (PCP)
​

Evaluation Appointment Forms

 We currently deliver these forms electronically for your electronic signature, using HIPAA-compliant methods. Therefore these are listed below for your review only, if you would like to familiarize yourself with our Evaluation procedures. 
Please review the HIPPA Privacy Regulations below before attending your first evaluation appointment.  You don't need to bring this document to your appointment.
Evaluation Consent
Rights and Responsibilities
HIPPA Privacy Regulations
​

Treatment Forms

We currently deliver these forms electronically for your electronic signature, using HIPAA-compliant methods. Therefore these are listed below for your review only.
Therapy Treatment Agreement
Rights and Responsibilities
Psychiatric (medication) Treatment Agreement
​
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  • Home
  • Our Providers
    • Amy Plavnick, LMSW
    • Dylan Broggio, LMSW
    • Debra Levine, PhD, LP
    • Kiley Hierl, PhD, LP
    • Fred Upton, PhD, LP
    • Lisa O'Donnell, PhD, LMSW
    • Laura M. Lokers, LMSW >
      • Presentations
      • Publications
    • JoAnne Shipman, LMSW
    • Sara Greschuk, LMSW
    • Gim Toh, PhD, LP
    • Katie Tucker, LMSW
    • Emily Fisher, LMSW
    • Christina LaRosa, MD
    • Kendall Gaspari, LLMSW
  • What we treat
    • Panic Disorder
    • Social Anxiety Disorder
    • Generalized Anxiety Disorder
    • Specific Phobias
    • Post Traumatic Stress Disorder
    • Illness Anxiety Disorder
    • Obsessive Compulsive Disorder
    • Trichotillomania
    • Hoarding Disorder
    • Body Dysmorphic Disorder
  • Services
  • New Clients
  • Patient Forms
  • Contact Us
    • Patient Portal
  • FAQ
  • Links
  • Classes
  • For Other Providers