Forms

By you filling out these forms ahead of time, it gives us more time to talk about why you are coming in and less time filling out the paperwork. However, if you cannot print or are having trouble viewing these, please contact me and I can work with you to get these. It is NOT a problem if you don't have these, please just come five (5) or ten (10) minutes early so you can fill them out before session.

If you're a new client, please complete the following forms and bring them to your first therapy session.

Therapist- Client Agreement (Please print two copies)
Notice of Privacy Practices
Adult Client Registration OR Child/ Adolescent Registration
Client Checklist of Concerns
Emergency Contacts

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to consent release of psychotherapy information.

Consent for Release of Information

If you would like me to share information with someone other than a provider (for example, your teacher, family member, friend, attorneys, Department of Human Services, employer, etc.), complete this form to authorize release of psychotherapy information.

Authorization for Disclosure of Protected Health Information