If you are a new client, please complete the following forms and bring them to your first therapy session.
- Confidential Client Intake
- Disclosure Statement
- Payment & Cancellation Policies
- Confidentiality Rights & Limitations
- Client Rights Regarding HIPAA Authorizations
- Fee Schedule
If you are interested in Couples Counseling, please also include the following 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. Please read the HIPAA information on page two carefully to understand your rights as a mental health patient:
Note: To download Adobe Acrobat Reader for free, click here.