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Resources for my CSTCM students

Below are examples of forms that you will need for your clinic. Make sure to modify the information so it is relevant for you and your clinic. 


- Notice of Policies and Consent Forms

- Notice of Privacy Policies

- Acknowledgement of Privacy Practices

- HIPAA Consent Form

- Authorization to Release Records

- Busines Associate HIPAA Agreement

Other Important Forms

- Mandatory Disclosure Form

- Record Keeping Checklist


More Example Forms

Consent to Treatment

HIPAA - consent to use

Deb Wood Intake form

Evolve Intake and forms

Female Specific Intake

Male Specific Intake

Infertility Specific Intake