Forms

[Still updating this section!!]

THE FOLLOWING DOCUMENTS PROVIDE  INFORMATION ABOUT MY PRACTICE. PLEASE REVIEW THEM BEFORE OUR FIRST SESSION:

  • Notice of Privacy Practices - Consent

  • Authorization for Release of and/or Exchange of Information

PLEASE COMPLETE THE FOLLOWING DOCUMENTS AND BRING THEM TO YOUR FIRST SESSION:

INTAKE PACKET: 

  • adult intake form

  • Adult checklist of concern

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

  • 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