Patient Portal

Use TherapyPortal to electronically access and sign your documents, as well as check your appointment time.

Psychotherapy Intake Form

Complete this form and return it to us before your first session

Office Policies and Informed Consent

Describes important information about the professional services and business policies of Rose City Geropsychology, LLC

HIPAA Notice of Privacy Practices

Describes how medical information may be used and disclosed

Note: you have the right to request access to your medical records. To do so, please email Meghan A. Marty, PhD, Privacy Officer, Rose City Geropsychology, LLC at

Authorization to Release Information

Gives us permission to share information about your psychotherapy with specific individuals or medical providers

Credit Card Authorization Agreement

Allows us to charge your credit card for services not covered by your insurance, such as co-pays/co-insurance, late cancellations, or no-shows

Informed Consent for Collaterals

Describes the role and responsibilities of another person whom we may invite to participate in your treatment, such as a spouse, family member, or friend

Informed Consent for Telehealth

Describes benefits and risks of using telehealth for remote psychotherapy sessions

No Surprises Act Standard Notice