Intake Forms

If you're a new client, please complete the following Client Intake Packet and bring this to your first therapy session.

Client Intake Packet:

  • Client History & Information
  • Consent to Treat
  • Receipt of Notice of Privacy Policy (HIPAA)
  • Credit Card Authorization

*Read Only:

**If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), request to complete a Release of Information Form.

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

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