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Helpful Forms

If you're a new client, you will need to complete some combination of the following forms - depending upon what type of services you will receive.  After scheduling our first session, I will let you know which forms need to be completed.  Please complete them and bring them to our first therapy session.

  • Intake Form - Adult
  • Intake Form - Minor
  • Consent for Clinical Treatment Form - Adult
  • Consent for Clinical Treatment Form - Minor
  • Agreement Regarding Minor Children
  • Notice of Privacy Practices Form
  • Credit Card Authorization 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:

  • Consent for Release of Information

Intake Form - Adult 2016
 
Intake Form - Minor 2016  
Consent for Clinical Treatment Form - Adult 2016  
Consent for Clinical Treatment Form - Minor 2016
 
 
Agreement Regarding Minor Children 2016  
Notice of Privacy Practices 2016
 
Credit Card Authorization Form 2016  
Consent for Release of Information 2016  
   

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Helpful Forms

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