It's great that you're taking steps toward self-care by preparing for your appointment!
Please print, complete, sign and bring the following 3 forms to your first appointment:
- Client Information
- Consent for Treatment (requires signature that you've reviewed and retained items listed under "For Your Records")
- Financial Consent/Agreement
For Your Records, please review the following information and retain: (no need to print and bring these forms to your appointmnt)
- Rights to Privacy Notice
- Office Policy and Fee Schedule
- Professional Disclosure
- Social Media Policy
- Parent Info (only needed if identified client is under 18 y/o)
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete/sign this form and bring to your appointment:
- Authorization for Use or Disclosure of Protected Health Information (Individual Clients)
- Authorization for Use or Disclosure of Protected Health Information (Couples)
Note: To download Adobe Acrobat Reader for free, click here.