If you're a new client, please complete the following forms and bring them to your first therapy session. *Please read all infomation on my Rates and insurance page, you will be asked to sign a form that you have read infomation and agree to conditions at your first appointment. Thanks in advance.
- 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|
|For Medicaid Clients Only|
Substance Abuse clients only:
|Self Evaluation Sheet|
|Self Evaluation of Drug Use|
|Barriers Questionnaire (Alcohol)|
|Barriers Questionnaire (Drug)|
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