If you're a new client, you can print out and complete the following forms and bring them to your first therapy session. If you are coming in as a couple, each individual will need to complete a set of forms. When coming in for your initial appointment, we will also need to make copies of your State issued ID, the insurance card, and the birth certificate of the client if he/she is a minor. Please remember to come in at least 10 minutes prior to your appointment time.
***Only Tricare carries need to complete the Tricare OHI.
- Client Information Form
- Informed Consent Form
- Insurance or Private Pay Agreement
- Notice of Privacy Practice Acknowledgement
- Intake Assessment
- ***Tricare OHI
Formas en Espanol:
- Formulario de Informacion del Cliente
- Consentimiento Informado
- Evaluacion de la Ingesta
- Aviso de Practicas de Privacidad
- Acuerdo de Seguro o de Pago Privado
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here.