Forms

During our first session, there are several forms that will need to be completed. If you would like, you can download the forms below, complete them, and bring them with you. I am happy to answer any questions you may have about these documents.

Intake Form
This form tells me about you and why you are considering counseling at this time. Please complete as much information as possible; however, feel free to skip over items that are not applicable to your circumstance.

Service Agreement 
This form tells you about how we can work together, and about my policies and practices.

Privacy Notice
This form tells you specifically about my privacy policies, confidentiality, and the legal limitations of confidentiality.

Insurance Form
This form contains your insurance information so that I can bill your insurance company.

Release to Primary Care Physician
This form tells me whether or not you want information sent to your Primary Care Physician. Some clients want me to provide brief periodic updates to their physicians, others do not. Releasing this information to physicians is optional, and this form indicates your choice.

Depending upon your insurance plan, there may be additional forms to complete during our first session and/or on a regular basis.