If you're a first-time client, please complete the following forms and bring them to your first session:
- Client Intake Form
- Confidential Patient Information Form
- Release to Primary Care Physcian
- Notice of Privacy and Confidentiality
- Authorization for Filing Insurance, Agreement to Pay for Missed Appointments
If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form. You do not need this form for the first session unless you need me to coordinate care with a doctor other than your primary care physician.
- Consent to Release Information Form
�
 Client Intake Form |
|
 Confidential Patient Information Form |
|
| Release to Primary Care Physcian |
|
| Authorization For Filing Insurance, Agreement to Pay for Missed Appointments |
|
| Consent to Release Information |
Note: To download Adobe Acrobat Reader for free, click here.