Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session. 

  • Client Intake form
  • Consent for Clinical Treatment
  • HIPPA
If you would like to use your credit card or debit card, please fill out the following form:
  • Credit Card Authorization

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, school counselor, etc.), complete this form to authorize release of information:

  • Consent for Release of Information
Consent for Clinical Treatment Form 2010 Intake Form - Minor 2010
Consent for Release of Information 2010  HIPPA 2010
Intake Form - Adult 2010

Credit Card Authorization Form 2010 

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