(Regarding the Questionnaires)
- Please Read -
Select each red document symbol below
to download the questionnaire to your computer,
after reading the HIPAA details.
Print the first 3 documents,
answer the questions and bring them to your appointment.
All sessions and questionnaire answers are uploaded to the Len Ochs Ph.D. database, in anonymous form for research purposes and for restoring practitioner session data should the need arise.
All traces of patient identification are removed from these uploads. The nature of the anonymous form prevents patient information from being associated with the patient, to protect patient privacy.
The purposes of this information is
(1) To allow the Chrysalis practitioner to receive session data and questionnaire answers to benefit treatment choices.
(2) To enable studies to quantify and better understand patient improvements in functioning, and how the Chrysalis may be configured to assist in bringing about improvements in functioning.
(3) The use of these online questionnaires implies that the person completing the forms is in agreement with the intent and expression of the use of the information.
If the user is not in agreement...
If the user is not in agreement with the intent of this notice, that person may access downloadable paper and pen forms. The downloadable forms are available in the Questionnaire box to the left.
Follow the instructions in the box (ie. choose each of the forms, print it, fill out the information asked and bring it to your appointment.)
The e-mail address you provide is used to encrpypt a unique identity for each person in the database; it is not used for communication purposes by Dr. Len Ochs or his company.
If you prefer to not use your usual e-mail address, you may create a new e-mail account to use for the purposes of our questionnaire system. It is necessary that you remember the the e-mail address provided to your practitioner to enable them to find your information in the database.
Please also coordinate with your practitioner who may wish to communicate with you by e-mail and will need an address where you can be reached.