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A Journeyof a Thousand Miles Begins with A Single Step

Initial Session Forms

 If you're a first-time client, please review, complete, sign and date the first 3  PDF forms and bring them to your first session. The last two forms are for your review and to keep for your personal files.  

* (Please note that even if you are not intending to pay by credit card, I ask that you fill out the credit card authorization.  This authorization remains on file if you no-show for your scheduled appointment,  do not give a 24 hour cancelation notice or if a session is conducted by phone.  Your card will be charged for this one time fee, as stated in my Disclosure Statement.)

1.   Intake Form

2.  Receipt of HIPAA & Disclosure Statement 

3.  Credit Card Preauthorization  

4.  Disclosure Statement

5.  Notice of Privacy Practices 


I have included an Insurance Questionarre to help you determine if reimbursements for your psychotherapy services are available from your insurance company.

Insurance Questionnaire


 

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


Helpful Forms

Click here to view and print forms for your appointment.

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