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

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