Helpful Forms

img

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

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

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

 

Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  
Energy Medicine Services Disclosure Statement and Agreement  
Informed Consent Form

HIPAA Privacy Authorization From
 

Note: To download Adobe Acrobat Reader for free, click here.

Contact Us

We look forward to hearing from you