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
![]() |
(1). New Client: Intake Form |
![]() |
(2). New Client: Limits of Confidentiality/Therapy Cancellation Policy |
![]() |
(3). New Client: Notice of Privacy Practices |
![]() |
(4). Telehealth Informed Consent |
(5). Career Intake Form |
|
![]() |
(6). Insurance, Psychiatrist, primary care Physician |
![]() |
(7). Minor Consent Form (Parent) |
Note: To download Adobe Acrobat Reader for free, click here .