Helpful Forms

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

• Client Registration Form
• Client Adult Intake Form
• Adolescent Intake Form (ages 13-17)
• Client's Parent Intake Form (ages 6-17)
• Limits of Confidentiality/Therapy Cancellation Policy
• Notice of Privacy Practices- H IPAA
• Federal Notice Summary (HIPAA Rules)
• Youth Behavioral Survey (Parent Form)
• Youth Behavioral Survey (Adolescent 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 .