There are six (6) items contained in our form packet. Please read the description of each item and instructions for its use before proceeding to the forms.
New Client Information
Please print this five (5) page new client questionnaire and bring it with you to your first appointment.
Health Insurance Claim Form
Please print this single-page insurance information form, fill it out, and bring it with you to your first appointment.
Notice of Policies and Practices to Protect the Privacy of Your Health Information
Please read this four (4) page information bulletin concerning privacy policies.
Receipt and Acknowledgment of Notice
Please print this single-page form and fill in your name, date of birth and social security number, sign and date it, and bring it with you to your first appointment.
Psychotherapist Patient Services Agreement
Please print and read this six (6) page information bulletin about professional services and business policies and bring it with you to your first appointment.
Signature Page
Please print this single-page form, sign and date it in two places as indicated, and bring it with you to your first appointment.
