Helpful Forms

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. 

•  HIPAA Notice of Privacy Practices
• Client Information Form
• Informed Consent Form
• Informed Consent Form for Telehealth
• Insurance or Private Pay Agreement
• Notice of Privacy Practice Acknowledgement
• Intake Assessment

***Only Tricare insurance carriers need to complete the Tricare OHI.

• *** 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
• Consentimiento Informado de Telesalud 2020

If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here .