Forms & Policies

If you are a new client, please complete the following online forms before your first full therapy session (they are not necessary before your 30 minute complimentary Good Fit meeting).

• Confidential Client Intake
• Practice Disclosure, Policies, and Procedures

If you would like to fill the forms out on paper, please print and 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

Though it is not currently the focus of my practice, I have years of experience conducting Couples Therapy. On occasion, I transition individual work into couples work. If you are transitioning within my practice to Couples Counseling, please also print and complete the following form:

• Couples Therapy Disclosure Addendum

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:

• Authorization to Release Information & HIPAA Privacy Rights

Note: To download Adobe Acrobat Reader for free, click here .

Confidentiality & Privacy Policy:

The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.

Legal exceptions and requirements include:

• Suspected child abuse, or dependent/disabled adult or elder abuse, which I am required by law to report to the appropriate authorities immediately.
• If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
• If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I must take further measures without their permission, as required by law, in order to ensure their safety.
• If my notes and records about our sessions are legally subpoenaed for any reason I will remain your advocate, and be advised by an attorney as to the minimum responses that are required.

Please review the following forms for a complete and thorough review of the exceptions to your confidentiality, your rights as a mental health patient regarding medical records, and my business policies.

• Disclosure Statement
• Payment & Cancellation Policies
• Confidentiality Rights & Limitations
• Client Rights Regarding HIPPA Authorizations