Forms

To the right are all the forms you will need for our first session together:

If you are seeking individual therapy as an adult (over 18 years of age), please fill out:

• Client Information - Adult Form
• Informed Consent & Authorization for Psychotherapy
• Notice of Privacy Practices
• Financial Responsibility

If you are seeking couples or family therapy, please fill out

• Client Information Adult Form - one each
• Informed Consent & Authorization for Psychotherapy - one each
• Notice of Privacy Practices - one each
• Financial Responsibility - one per couple

If you are a parent or parents seeking treatment for your minor child under the age of 18, please fill out and/or sign each of the following forms yourself:

• Client Information - Minor Child/Adolescent Form
• Informed Consent & Authorization for Psychotherapy
• Notice of Privacy Practices
• Financial Responsibility

Once we have been meeting for a few times, you may need to fill out the following:

If you would like to bring your spouse, parent or other significant family member or friend to therapy with you for either a one-time or occasional appearance as a means of helping you, please have your family member or friend fill out this form:

• Collateral Agreement

If you would like me to dialogue with your doctor, lawyer or someone else important to you about your therapy, please fill out this form:

• Release of information

NOTE: FINANCIAL RESPONSIBILITY FORM MUST BE FILLED OUT EVEN IF INSURANCE IS REIMBURSING FOR YOUR TREATMENT.