Forms

In order to maximize our time together please click on, print out and fill out the forms below before our first meeting. If you are unsure or have any concerns about anything on these forms simply leave the item in question blank. We will take some time to go over your information regardless and can address any concerns at that time.
If you enter therapy as a couple both partners should fill out all forms separately.
I look forward to meeting with You. 

• Adult Intake Form (18 or Over Individual)
• Parent of a child Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy
• Telehealth Services Consent and Instructions
• Credit Card Authorization Form

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

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