New Clients: Please Read

Please review these documents prior to our first session. They can be read or printed by clicking on the links below. Click the right mouse button for the option to save a copy to your computer. If you have any trouble accessing the forms, please alert me and I’ll send you copies via e-mail or USPS. I will also review these forms with you during your first visit.

Informed Consent: The informed consent form provides information about my professional background, the process of psychotherapy, and my policies for scheduling, communication, fees, insurance, confidentiality, and additional office policies. If you have questions after reading this form, please bring them up when we meet.

Notice of Privacy Practices: This document details your rights and protections related to the use and disclosure of your Protected Health Information (PHI) under the Health Insurance Portability and Accountability Act (HIPAA).

New Clients: Print and Sign

Please bring signed copies of these forms to your first session.

Receipt of Notifications: Once you have read the Informed Consent and Notice of Privacy Practices forms, please print and sign this form to indicate that you have access to and have read all forms. Bring this to our first session.

Client Information Form: Please complete the Client Information Form and bring it to our first appointment. This will help you share important details with me while allowing our first meeting to unfold more naturally. Note: If you would like to type and save your responses in this fillable form, save a copy to your computer before entering information.

Additional Forms

Authorization Form: If you intend to have me share or discuss your Protected Health Information with other health care providers, agencies, family members, or other people you wish to be involved in your treatment, I will ask you to complete this form at some point.

For Parents: If your son or daughter is receiving psychological services from me, you may have some questions about the treatment process, whether we can exchange information, how I respond to high‐risk behavior or situations, and how to coordinate invoicing and payment of fees. Some of these answers depend on whether your child is a minor (under 18) or an adult. This document should answer most of your questions.