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Senior Citizen Couple
Senior Citizen Couple

Intake Forms

If you are a new client please complete ALL of the forms in the Therapy Forms Packet and bring them to your first therapy session.  The Therapy Forms Packet can be found HERE.  Please print this form out, read it, complete it, and bring it with you to your initial appointment.

 
The Therapy Forms Packet includes the following forms:
 
  • Therapy Information and Treatment Consent Form
  • HIPAA Privacy Consent Form
  • Financial Agreement Form
  • Client Information Form

 

Each new client should also print out and complete the appropriate Background Questionnaire and bring it to your first therapy session.  Please print out and complete the Background Questionnaire appropriate for you:  ADULT Background Questionnaire; TEEN Background Questionnaire; COUPLES Background Questionnaire; or the  PARENT Background Questionnaire and bring this form to the first appointment as well.  (Parents of Teens should EACH complete a Parent Background Questionnaire INDEPENDENTLY of their partner.)

 
If you would like me to coordinate your care with another provider (e.g., your psychiatrist, primary care physician, etc.), please complete the Authorization to Exchange Clinical Information and bring it to your first therapy session.  This form can be found HERE.

 
 

 

 

 

   
   
   
   
   
   

 

 

 

Helpful Forms

Click here to view and print forms for your appointment.

Click Here