Privacy, Policies, & Forms
For your convenience, I have provided some of my forms electronically. If you have any problems downloading or printing the form, please let me know. I can also mail/email forms to you before your first appointment for your convenience.
All New Clients
Disclosure Policy Statement and HIPPA Privacy Notice. I recommend reading the Disclosure Policy Statement and HIPAA Privacy Notice prior to the first session. It is also helpful information for teens. Please print and sign the signature page (the last page) and bring it to the first session.
Insurance Authorization Form - If you would like me to bill your insurance.
All New Clients
Disclosure Policy Statement and HIPPA Privacy Notice. I recommend reading the Disclosure Policy Statement and HIPAA Privacy Notice prior to the first session. It is also helpful information for teens. Please print and sign the signature page (the last page) and bring it to the first session.
Insurance Authorization Form - If you would like me to bill your insurance.
Child, Teen, and Adult Intake Forms
The Intake Forms below take about 20 minutes to fill out. Please print and complete the form for the individual seeking treatment or for the individual for whom the insurance will be billed.
Adult Registration Form
Adolescent Registration and Consent Forms - to be completed by parent or legal guardian
About Me - Optional form for teens willing to share their concerns and what they are hoping will be the outcome of counseling.
Child Registration and Consent Forms - to be completed by parent or legal guardian
Authorization Forms to communicate with others
I will request these forms only if needed to authorize communicate with other professionals such as your doctor or your child's school.
Authorization to release information for a minor
Authorization to release information for an adult
The Intake Forms below take about 20 minutes to fill out. Please print and complete the form for the individual seeking treatment or for the individual for whom the insurance will be billed.
Adult Registration Form
Adolescent Registration and Consent Forms - to be completed by parent or legal guardian
About Me - Optional form for teens willing to share their concerns and what they are hoping will be the outcome of counseling.
Child Registration and Consent Forms - to be completed by parent or legal guardian
Authorization Forms to communicate with others
I will request these forms only if needed to authorize communicate with other professionals such as your doctor or your child's school.
Authorization to release information for a minor
Authorization to release information for an adult