Intake Forms

Below you will find links to five Intake Forms and instructions for each form:

1. Client Information – please print, complete, and return to me before the first session.
2. Professional Disclosure and Informed Consent – Please print and sign this form and return to me before the first session. Please also print a copy for yourself or request a hard copy of this document from me at any time.
3. Communication Policy - Please print and sign this form and return to me before the first session. Please also print a copy for yourself or request a hard copy of this document from me at any time.
4. Notice of Privacy Practices – Please print a copy of this document for yourself or request a hard copy of this document from me at any time. This document includes (on page 3) an ACKNOWLEDGMENT OF RECEIPT OF NOTICE OF PRIVACY PRACTICES (HIPAA) document. Please sign and return this “acknowledgment” form to me before the first session.
5. Informed Consent to Use Teletherapy please print, complete, and return to me before the first session.