If you are a new adult client, please complete the following forms and bring them to your first therapy session.
- Client Psychotherapy Intake Form
-
Psychotherapy/Client Services Agreement
- HIPPA Notice
If you are a parent with a new child or adolescent client, please complete the following forms and bring them to your first therapy session.
- Child Psychotherapy Intake Form
-
Child / Family Psychotherapy/Client Services Agreement
- HIPPA Notice
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
Note: To download Adobe Acrobat Reader for free, click here.
Adult Forms
 Couples/Families Intake Form |
|
| Client Psychotherapy Intake Form |
|
| Psychologist/Client Services Agreement |
|
| HIPPA Notice |
|
| Consent to Release Information |
| Child / Adolescent Psychotherapy Intake Form
|
| Child / Adolescent Psychological Services Agreement
|
| HIPPA Notice
|
| Consent To Release Information
|