To be prepared for your first visit with us, please see below.
Section One: Print, complete, and bring to your first appointment:
- Adult Psychotherapy Intake Form (18+)
- Child Psychotherapy Intake Form (Under 18)
- Child Psychotherapy Intake Form Cover Sheet (Under 18)
- Informed Consent
- Patient Care Communication Form
- Treatment Plan Acknowledgement Form
- Payment Acknowledgement Agreement Form
- Privacy and Rights Acknowledgement Form
Section Two: Reference/Read Only and/or Save/Print for your records:
- Consent for Treatment/Limits of Liability
- HIPPA - Consent for Use and Disclosure of Health Information
- Patient Rights & Cancellation Policy
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here.