On this page you will find important documents to review and complete before our first session. If you have any questions or concerns upon reading or completing these forms, please bring them to my attention.
Please complete and/or sign and bring to your first visit (four forms):
1) Contact Information Form: This document provides your contact information and whom you would like me to contact in case of an emergency.
2) Office Policies: This document outlines my office practices and explains the nature and parameters of psychotherapy. It also contains important information about matters of confidentiality.
3) Notice of Privacy Practices: Health providers are required by law to provide you with this notice, which explains privacy practices with regard to your Protected Health Information (PHI). Please read carefully as it explains your rights and protections related to the use and disclosure of your health care information.
– Either
4) Adult Information Form: Adult Information Form: This document provides more detailed information about your and your health history. Note for couples therapy, each partner will complete his/her own form.
– Or
5) Child Information Form: This document provides more detailed information about your child and his/her health history.
While in treatment
Release of Information: If you want me to speak with someone like your psychiatrist, family doctor, your child’s teacher/school, etc, you will need to complete this document.
Consent to Videoconferencing and Teletherapy: After we begin treatment, we may choose to make use of secure video for conducting therapy sessions if you are unable to attend in person.
