Forms

For your convenience, I am providing the following forms in PDF format, so you can download, print, read and them fill them out as appropriate prior to our first appointment, if you choose. If you need it, you can download the free Adobe PDF reader here.

Forms for all clients

1. Client Intake Form
2. Office Policies
3. Notice of Privacy Practices
4. Acknowledgement of Receipt of Notice of Privacy Practices
5. Credit Card Authorization
6. Insurance Agreement and Policy

Special client forms

7. Authorization to Release/Request Confidential Information
8. Informed Consent for Online Therapy
9. Parental Permission to Treat a Minor