Welcome. If you're coming in for the first time,  please review, complete and sign (if necessary) the following forms, then bring them to your first session. Thanks.

• Client Intake Form

• Confidentiality & limits thereof

              Please read before your 1st session

• Cancellation Policy

               Please read before your 1st session

• H.I.P.P.A. Regulations 

• Policy and Procedures 

               Please read in entirety, download and sign the last page, and   
               bring in signed page to your 1st session 
 

• My Treatment Plan (issues to work on)

               For you to think about right now. We will work with this 
               treatment plan more thoroughly in the near future but it 
               would be good for you to start thinking about some of  
               these things that you wish to work on.

 

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), please complete this form:

• Consent to Release Information Form

 

Client Intake Form
Confidentiality and Cancellation Policy
Consent to Release
H.I.P.P.A. Regulations
Policy and Procedures
My Treatment Plan

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




































































UA-28529821-1