The Disclosure of PHI form allows me to communicate with a person or facility to coordinate care. For many people, this is a spouse, parent or doctor. If you do not want me to have contact with anyone at this time, please write “DECLINED” anywhere on the form, sign at the bottom and return to me with the other forms.
Please be aware that there are always potential risks when emailing sensitive documents. In addition to the forms above, please provide a copy of your drivers license and the front and back of your insurance card.
Contact Information
Phone – +1-413-424-9808
E-mail – lauren@reinmanntherapy.com
Location – River Vale, NJ
In-network and out-of-network insurance accepted
In Person and Telehealth Services Available
Lauren Reinmann Psychotherapy 