Forms for New Clients
After you have made your initial appointment, you will be given a password to open the documents below. You should complete and sign these forms and then bring them to our first meeting. If you would like for me to bill your insurance company, please bring your insurance card to our first meeting also.
After you have made your initial appointment, you will be given a password to open the documents below. You should complete and sign these forms and then bring them to our first meeting. If you would like for me to bill your insurance company, please bring your insurance card to our first meeting also.
Informed Consent This document describes how therapy
works, the terms of payment, and privacy policies. This
is a 6 page document as follows: Each person coming to
the session must sign the following: Consent to
Treatment (pages 1-3); adolescents may also sign
Payment Arrangement (page 4) Privacy Policy
Acknowledgment (page 5) For children, Consent to Treat
Minors (page 6); needs BOTH parents’ signatures This
document describes how therapy works, the terms of
payment, and privacy policies.
In this form, you will provide me with your current
contact information as well as information about your
current situation and history so that I can maximize my
effectiveness in helping you reach your goals. Each
adult should complete his/her own.
This document describes my privacy policy in full
detail. I comply with federal standards for protecting
my client’s policy (which is also why I am unable to
communicate via email). This is for your records only;
you do not need to bring it with you to the first
meeting.