Helpful Forms

** If you are a NEW CLIENT , please complete and Scan in a PDF the following four forms ( 1,2,3 & 4)  (Please do Not take a photo of the forms and send)

• 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 (6) 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 (7)

*  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
Notice of Privacy Practices	(3). New Client:  Notice of Privacy Practices
Telehealth Informed Consent <	(4). Telehealth Informed Consent
Career Intake Form	(5). Career Intake Form
Authorization to Disclose Information Form	(6). Insurance, Psychiatrist, primary care Physician
Minor Consent Form	(7). Minor Consent Form (Parent)

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