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Client Check-in

Appointment Time:
Time
HoursMinutes
Check-in Time:
Month
Day
Year
Time
HoursMinutes

If you have an appointment with us today, please take a moment to check in using the form below. This helps us prepare for your session and keep things running smoothly. Thank you for your time and cooperation.

 

Privacy Disclaimer

The information you provide on this form is confidential and protected under applicable privacy laws, including the Health Insurance Portability and Accountability Act (HIPAA). It will be used solely for check-in and administrative purposes related to your care.

We do not share your personal health information without your consent, unless required by law. All data is submitted through a secure, encrypted system.

If you have any questions about how your information is handled, please speak with a staff member.

 

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© 2025 Franza, Psychological Services, PLLC   I   2524 E. Indian School  Rd Phoenix, AZ    I   602-430-1458   I   info@doctorfranza.com  

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