* If you are a NEW CLIENT, please complete the following three forms (1,2 & 3) and bring them to your First therapy session.
- Client Psychotherapy Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
- Notice of Privacy Practices
* If you would like me to coordinate care with another provider: (for example, your Psychiatrist, primary care Physician, PPO Insurance), complete form (4) to authorize release of psychotherapy information:
- Authorization to Disclose Information Form
* If you are a Parent seeking therapy for a MINOR, please fill out the form (5)
* Minor Consent Form
|Client Psychotherapy Intake Form||(1). New Client Intake Form|
|Limits of Confidentiality/Therapy Cancellation Policy||(2). Limits of Confidentiality/Therapy Cancellation Policy|
|Notice of Privacy Practices||(3). Notice of Privacy Practices|
|Authorization to Disclose Information Form||(4). Insurance, Psychiatrist, primary care Physician|
|Minor Consent Form||(5). Minor Consent Form (Parent)|
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