Helpful Forms

** If you are a NEW CLIENT , please complete and Scan in a PDF the following four forms ( 1,2,3)  (Please do Not take a photo of the forms and send)

• Client Psychotherapy Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy
• Telehealth Informed Consent 

** If you would like me to coordinate care with another provider: (for example, your Psychiatrist, primary care Physician), complete form (5) 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 (6)

*  Minor Consent Form

Client Psychotherapy Intake Form	(1). New Client:  Intake Form
Limits of Confidentiality/Therapy Cancellation Policy	(2). New Client:  Limits of Confidentiality/Therapy Cancellation Policy
Telehealth Informed Consent <	(3). Telehealth Informed Consent
Career Intake Form	(4). Career Intake Form
Authorization to Disclose Information Form	(5). Insurance, Psychiatrist, primary care Physician
Minor Consent Form Notice of Privacy Practices	(6). Minor Consent Form (Parent) (7). New Client:  Notice of Privacy Practices (HIPPA)

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