To be prepared for your first visit with us, please see below.
Section One : Print, complete (select either Adult or Child), and bring to your first appointment:
- Adolescent (14-17) Intake Packet
Or you may complete the Online E-Sign Adult or Child Intake - Please contact our administrative team and they will be able to email you the requested forms
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
Additional Forms Available Upon Request-
(Please contact our administrative team and they will be able to email you the requested forms)
Informed Consent for Telemental Health Treatment Form
Informed Consent & Health Risk Assessment (Adult 18+) Combo
Informed Consent & Health Risk Assessment (Adolescent 14-17) Combo
Informed Consent & Health Risk Assessment (Child 0-13) Combo
Therapist Acknowledgement Form
Authorization for Release of Information - If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete the form in PDF or Online E-Sign form can be emailed to you to authorize release of psychotherapy information:
PDF's of Additional Forms (Print As Needed)
- Informed Consent
- Patient Care Communication Form
- Treatment Plan Acknowledgement Form
- Payment Acknowledgement Agreement Form
- Privacy and Rights Acknowledgement Form
- Health Risk Assessment (Adults Only Ages 18+)
- Health Risk Assessment (Child Only Ages 0-17)
- Therapist Acknowledgement Form
- Authorization to Disclose Information Form
- Informed Consent for Telemental Health Treatment
- Acknowledgement and Consent to Use- Electronic Communication
Note: To download Adobe Acrobat Reader for free, click here .