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New Client Intake Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

 


Adult Intake Form


 

Adolescent Intake 



Child 5-10 yr old Intake 

 


Questionnaire for Couples

 

HIPAA

 

Credit Card Authorization Form



Limits of Confidentiality/Therapy Cancellation Policy
 



Authorization to Disclose Information

 

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:

 

 

 

 

 

 

 

 

 

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

 

 

 

 

 

 

 

 

 

 

Helpful Forms

Click here to view and print forms for your appointment.

Click Here