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Forms
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To save time on your initial visit, please print out and complete the two forms below:
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(You will need an Adobe® Acrobat reader to view and print out the forms. If you do not have a reader, or are having trouble printing out the form, you can obtain a free and current copy through this link.)
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- Client Intake Form (pdf file; 16K) This form provides me with some general background information and contact information.
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- Client Consent Contract (pdf file; 17K) This Agreement is intended to provide you with important information regarding the practices, polices and procedures and to clarify the terms of the professional therapeutic relationship between Therapist and Patient.
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Optional Forms: These forms may be required. If either, or both, are needed, I will let you know.
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- Consent to Release Confidential Information (pdf file; 13K) This form gives the therapist written authorization to share your confidential information.
- Telemedicine Informed Consent Form (pdf file; 12K) This form gives the therapist written authorization to provide health care delivery using
interactive audio, video, or data communications (For example, telephone consultation).
- “No Secrets” Policy for Family Therapy and Couple Therapy
(pdf file; 82K) This written policy is intended to inform you, the participants in family therapy or
couple therapy, that when I agree to work with a couple or a family, I consider that couple or family (the treatment unit) to be the patient.
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Updated 5/8/12
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