Notice of Richard E Hicks, PhD joining
HRC Behavioral Health & Psychiatry, PA
4201 Lake Boone Trail, Suite 201, Raleigh, NC 27607, (919) 785-0384
(Effective 07/15/2013)
It is with great pleasure that I am writing to let you know that effective 07/15/2013; I will be joining HRC Behavioral
Health and Psychiatry, a group practice with offices in Raleigh and Chapel Hill-Durham.
Why am I joining HRC?
--HRC will offer my clients and me convenient access to a great team of clinicians. HRC is one of the oldest and largest
clinical practice groups in the southeast - a comprehensive, multi-disciplinary group practice of psychologists,
psychiatrists, social workers, and marriage and family therapists offering quality mental health services in both Raleigh
and Chapel Hill-Durham.
--HRC will offer my clients and me convenient access to an experienced team of administrative support staff, who will
handle the business side of my practice (e.g. insurance billing, client accounts, electronic health records, etc.). This will
allow me to focus primarily on client care - more time for clients and opportunities to provide a wider array of services.
-- HRC will provide my clients and me the ability to meet in several convenient locations – my current office on Oberlin
Rd; an office near Rex Hospital in Raleigh; and an office at the Europa Center, just off I-40 between Chapel Hill and
Raleigh.
How might this change our work together?
-- Our work together should not change very much. Our interactions and communication together will remain the same
(e.g. scheduling; appointment hours; phone & email availability; etc).
-- We may meet in a new office location, depending on the day, the time, and your preference of meeting location. My
“main” office will move to 4201 Lake Boone Trail, approximately 7 minutes (3.5 miles) away from my Oberlin Rd office.
-- There will be a few new forms to fill out, to make sure the HRC staff have what they need to file your insurance, keep
track of billing, and take care of all that “paper work.”
Before you leave the office today, please sign this form and the REH/HRC Authorization form. Please also complete the
other forms, either today or prior to our next appointment.
REH/HRC Authorization Form - Transfer & Exchange of Health Information with HRC
HRC Privacy Notice
HRC Missed Appointment Agreement
-Patient Services Agreement
Your signature below indicates that you have read this notice and received the forms listed above. Specifically, serves as
an acknowledgement that you have received the notice of privacy (HIPPA) form described above and
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Patient’s Name (Please print)
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Signature of Patient & Date
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Personal Representative (Please print)
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Signature of Personal Representative & Date
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Relationship of Personal Representative to Patient
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Witness (if applicable) & Date
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Responsible Party, if other than client (Please print)
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Signature of Responsible Party & Date
Notice of Richard E Hicks PhD joining HRC; Updated 07/02/2012