All forms needed are listed below:
New Client Paperwork:
If you're a new client, please complete the following forms and bring them to your first therapy session. The below forms serve as a consent for treatment. DO NOT date as we will do this then. Please bring your insurance card and photo ID to your first appointment.
1.) Client Information Form
2.) Consent and Authorizations Form
3.) Technology Consent Form
5.) Medical History Form
If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, school personel etc.), complete this form to authorize the release or receiving of information. (Note: we must have a release of information form on file for EACH individual that you would like us to contact)
1.) Release of Information Form
2.) Credit Card on File (Use this to place a credit card on file with the office)
The law protects the relationship between a client and a therapist, and information cannot be disclosed without written permission.
- Suspected child abuse or dependent adult or elder abuse, for which we are required by law to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person/s, we must notify the police and inform the intended victim.
- If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, we will take further measures without their permission that are provided to us by law in order to ensure their safety.
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