Forms

Once you have scheduled an appointment with me, you can download and print forms here.  Please fill out the appropriate forms and bring them with you to your first session.

Outpatient Services Contract/HIPPA: All clients need to thoroughly review this document. Please print and bring a signed copy of the signature page to our first appointment.

Client Information Form: Please print and fill out this form. Please bring this completed form to our first appointment.

Credit Card Consent Form: I require all clients to submit a credit card consent form. This authorizes me to charge your credit card in cases of nonpayment.

Release of Information: Please complete this form if you have other health care professionals that you would like me to share information with regarding your treatment. Examples may include: primary care physicians, psychiatrists, and other therapists.

outpatient services contract.pdf outpatient services contract.pdf
Size : 228.253 Kb
Type : pdf
client info form.pdf client info form.pdf
Size : 347.259 Kb
Type : pdf
CreditCardConsent.pdf CreditCardConsent.pdf
Size : 189.802 Kb
Type : pdf
Release of Information.pdf Release of Information.pdf
Size : 155.831 Kb
Type : pdf
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