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Emily Pimpinella, Psy.D.
About Dr. Pimpinella
Services + Insurance + No Surprises Act
Contact + Location
Notice of Privacy Practices + Forms
You may read my Notice of Privacy Practices below.
Notice of Privacy Practices
All my forms (such as Records Requests and Releases of Information) can be accessed and electronically signed through the Client Portal (link below). Just let me know what one you need and I will upload it for you. If you don't currently have access to the portal and would like to, please let me know and I can grant you access.
Below are PDF versions of forms used for releasing information and for records requests. If you are sending me a form, please call me and give me a heads up so I know to expect it, and also to navigate possible instances where I could be out of the office for a time period so we can discuss options.
Authorization for the Release of Confidential Information (Use this form if you want me to share your information and/or records with someone else.)
Records Request (Use this form if you are requesting your own records for yourself) *Please note that the in-person pick-up option is not currently available due to Covid-19.
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