A note about privacy and protection of your Protected Health Information (PHI):

Shawler Psychology, PLLC uses a paid version of Google Workspace which is compliant with the Health Insurance Portability and Accountability Act (HIPAA). There is a signed Business Associate Agreement with Google to ensure your privacy and protections of Protected Health Information (PHI). This agreement means that only Dr. Shawler of Shawler Psychology, PLLC has access to the information you submit.  

Dr. Shawler operates Shawler Psychology, PLLC and will be the only person who has access to the data and information submitted on this form. He is also the sole recipient of any emails sent to info@shawlerpsychology.com or pshawler@shawlerpsychology.com. Dr. Shawler cannot and will not share any  PHI with anyone unless you, the client, give explicit written authorization to disclose part of your PHI to select persons as part of your treatment coordination.

If you have any questions or concerns about sharing your information through this electronic means, please call or email Dr. Shawler (618-539-2155; pshawler@shawlerpsychology.com) and paper copies of forms can be provided to you to complete. You can also download and print forms directly from https://www.shawlerpsychology.com/client-forms.

Should your insurance change or you need to update your payment method on file, it is important to update and complete this form again. Please notify Dr. Shawler with any changes or updates as you continue your treatment.