Forms

Osika & Scarano Psychological Services, P.C.

Authorization to Release Private Health Information

Release of Information

Adults:

Children:

Online Forms

New Patient Packets

Other Forms

Authorization for the Transmission of ePHI
(Electronic Private Health Information)

Sliding Fee Scale

Please note: We recommend using a computer to complete forms online. Some phones run into issues submitting the information, and typing on a keyboard is often quicker and easier.

Credit Card Authorization