Helpful Forms

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

  • New Patient Registration (All Therapy Clients)
  • Client Intake Form (Adult Therapy Clients)
  • Child and Adolescent Intake Form (Child & Teen Therapy Clients)
  • Limits of Confidentiality/Cancellation Policy Form
  • Privacy Policy
  • Authorization to Release Information
  • Client Information Sheet
  • Coaching Welcome Packet

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

  • Consent to Release Information Form

 




Child and Adolescent Intake Form Form required for consent to provide services to children and adolescents


Privacy Policy Privacy Policy Copy for Patient Information and Signed Copy Required in File


Consent to Release Information Authorization to Release Information


Client Information Sheet Summarizes policies and duplicate copy of privacy policy for patient's own records


Coaching Welcome Packet Complete start-up coaching kit, including policies and Coaching Agreement


New Patient Registration Form required for consent to bill insurance for psychotherapy


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