Forms
 

Client Information Form

Notice of Privacy Practices (HIPPA)

Please download, print and sign both forms above. You may either fax or bring the signed forms to our office. The fax number is (972) 233-5568.

Please Note: You will require Adobe PDF Reader software to view and print these forms. You can download the FREE software by clicking on the logo on the right.

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Dr. Al Nazempoor,  Personal Coach & Psychotherapist
Phone: (972) 233-0181, or (214) 727-7717,  Fax: (972) 233-5568
Email: coachingei@yahoo.com