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