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Intake Forms

If you are a new client please complete ALL of the forms in the Therapy Forms Packet as well as the appropriate Background Questionnaire.  Please click on the blue links below to download these forms.  Then, please print, read, complete, and sign the forms and bring them 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.