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Helpful Forms

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  

Permission to Contact PCP

 

 
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.

 

Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE