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 Physician
- Notice of Privacy and Confidentiality
- Authorization for Filing Insurance, Agreement to Pay for Missed Appointments
The last form is not necessary for your first session.
|Client Intake Form|
|Billing and Insurance Form|
|Notice of Confidentiality and Privacy|
|Authorization to File Insurance; Missed Appointment Policy|
|Policy Consent to Release Information|
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.
Note: To download Adobe Acrobat Reader for free, click here.