Forms

A/ For Couples

  1. Demographic information: one copy per couple 

  2. Dyadic Adjustment Scale: complete individually 

  3. Attachment Style Quiz – Simple online quiz. Take and print out the results

  4. When we're not getting along: complete individually

  5. Problem area: complete individually

  6. Weekly check-in

  7. Do You Know Your Cycle?- complete individually

 

B/ To review and remit prior to first session

  • Notice of Privacy Practices - Consent

  • Authorization for Release of and/or Exchange of Information

 

A/ For Individual Counseling: [working on this section!!]

  1. adult intake form

  2. Adult checklist of concern

  3. child history form: please complete one of each of these forms per child

  4. release of information form

Insurance coverage question

  • Insurance: This form has questions to ask your insurance carrier to determine your benefits. I encourage you to obtain this information before your first session if you plan to submit for reimbursement of therapy charges.

Limit of therapeutic relationship