The following forms are important and will help us establish a clear and effective therapeutic relationship. To print the forms will require Adobe Acrobat Reader. If you do not have this program on your computer, you can download it for free by clicking here.
PLEASE PRINT, COMPLETE, SIGN, AND BRING TO YOUR FIRST SESSION:
Office Policies and Procedures
This form explains my office procedures and includes and agreement for psychotherapy services. If you have questions
after reading this form, please bring them up with me when we meet.
HIPPA Notice of Protected Health Information
I am required by law to provide you with a copy of the HIPPA Notice of Privacy Practices. This notice is meant to help you understand your rights and protections related to the use and disclosure of your protected health care information.
Authorization to Release Information
Complete and sign this form to authorize care coordination with your other health care providers (for example, your psychiatrist and/or primary care physician).
Biographical Information – Adult Intake Form
Prior to our first session, please complete the patient information form. The information you provide will help me to get to know you more quickly and to tailor therapy to your unique needs.
Biographical Information – Child Intake Form
Similar to the Adult Intake Form, this form provides me with important details about your child. Please take the time to fill this form out completely. The information you provide will assist me to understand the scope of your child’s needs and to focus therapy on the best treatment approach.