Forms

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

• Service Agreement Form
• Client Psychotherapy Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy
• Authorization of Release Information to Insurance Company - only if you are using an insurance provider.
• HIPPA Patient Consent Form
• COVID-19 Liability Form

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

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, Click here.