Initial Therapy Consultation Forms
To minimize paperwork at our initial consultation, please review, print, and sign the forms below and bring them with you to the consultation.
Adult History and Checklist of Concerns
Psychotherapist-Patient Services Agreement
Patient Acknowledgement
Please read my Notice of Privacy Practices to ensure that you are familiar with how psychological and medical information may be used and disclosed and how you can get access to this information.
Notice of Privacy Practices
Please complete a Release of Information form if you would like me to be able to consult with your other clinicians/providers regarding your treatment (for example, psychiatrists, former therapists, physicians, school personnel, agency representatives).
Consent to Release Information Form
For Child and Adolescent Patients:
Please print, sign and send or bring a copy of the Minor Consent and bring a completed Child/Adolescent History Form to the first session.
Minor Consent
Child/Adolescent History Form
To minimize paperwork at our initial consultation, please review, print, and sign the forms below and bring them with you to the consultation.
Adult History and Checklist of Concerns
Psychotherapist-Patient Services Agreement
Patient Acknowledgement
Please read my Notice of Privacy Practices to ensure that you are familiar with how psychological and medical information may be used and disclosed and how you can get access to this information.
Notice of Privacy Practices
Please complete a Release of Information form if you would like me to be able to consult with your other clinicians/providers regarding your treatment (for example, psychiatrists, former therapists, physicians, school personnel, agency representatives).
Consent to Release Information Form
For Child and Adolescent Patients:
Please print, sign and send or bring a copy of the Minor Consent and bring a completed Child/Adolescent History Form to the first session.
Minor Consent
Child/Adolescent History Form
