Registration

Welcome to my practice!

If we have made an appointment to meet, you may complete the Registration Packet of forms in several different ways. You may download them and bring them to our first meeting. Or you may fax the completed forms at any time. My secure fax number is 785-856-8959.  If you prefer, you may complete the Packet in my office during our first visit. The only advantage of downloading or faxing is that we will have more time to talk during our first session. Please bring any questions about any of information in this packet to our first session together.

This Registration Packet contains several different forms. Federal and State laws account for both the content and length of these forms. Specifically, I am required to provide you with information about my privacy practices, your rights as a client, the practice of psychology, the assignment of insurance benefits, and about my own training to provide you with services. The Federal requirements are found in the Health Insurance Portability and Accountability Act of 1998 (HIPAA), and the Kansas State statues are found in K.S.A. Chapter 74, Article 75.

It will take several minutes to complete these forms. Some of the questions ask for personal health information. I want to assure you that I take very seriously my obligation to protect this information from exposure to others.

My office is located in downtown Lawrence, at 1012 Massachusetts Street, Suite 206. The building is on the east side of the street, between 10th and 11th Streets. You will find the waiting area at the top of the stairs. I will meet you in the waiting area. Voice mail messages may be left at 785-840-9820. You will become a client at the time we meet and agree to work together.

I look forward to our first meeting!

John M. Robertson, Ph.D.

Registration Information (PDF)
Health Information (PDF)