Forms

During our first session, you will be required to complete a few forms. If you would like to review and complete these forms prior to our initial appointment, you can download and print them here.

Consent for Treatment:  this form details guidelines for practice, consent for treatment and office policies.  Please review and sign.  

Notice of Privacy Practices:  this form details the HIPAA law and rights regarding your health information.  Please read.

Acknowledgement of HIPAA Notice:  this form confirms that you have been made aware of the Notice of Privacy Practices.  Please sign.  

Intake form:  please complete this form to provide demographic, insurance, and background information to inform the treatment plan.  

Release of Information:  If there is another provider (such as a psychiatrist or primary care physician) or third party that you would like me to discuss your health information with, you must complete and sign this form before I can release any protected information.