Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

Client Psychotherapy Intake Form

Participants Application And Health History

Rules and Regulations

Authorization for Emergency Medical Treatment

Express Assumption of Risk, Release of Liability, Waiver of Claims And Indemnity Agreement

Limits of Confidentiality/Therapy Cancellation Policy

HIPAA Form

Credit Card Authorization Form

Consent to Communicate PHI Electronically

Minor Child Intake Form (Under 15 Years Old)

Adolescent Intake Form (15-17 Years Old)

Disclaimers

Adult Intake Form

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Disclose Information Form

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