Helpful Forms

If you're a new client, please download and complete forms #1, #2, #3, #4, #5 and #6.

Please bring them to our first therapy session. On the Notice of Privacy Practices (#3), you only need to print out the last page that is titled: Acknowledgement of Receipt of Notice of Privacy Practices. You will need to print out the other forms and complete them before our initial meeting. Thank You.

When we meet, we will review the information together.

• #1 Consent to Treatment

• #2 Pre-Counseling Intake Form

• #3 Notice of Privacy Practices

• #4 Letter Concerning No Surprises Act

• #5 Tele-medicine Informed Consent Form

• #6 Consent to Treatment during the Covid-19 Pandemic

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

• Authorization to Disclose Information Form

FYI: Your email address will not be used for any email lists or publications.
Note: To download Adobe Acrobat Reader for free, click here.