Client Forms

Client Forms

You may want to read these forms before we have an initial phone call, so that you can ask any questions you may have.

Information and Consent

Please read this form before our first session, let me know if you have any questions or concerns, and you may sign it after our discussion.

Special Consent for Telehealth

Currently all therapy and evaluation sessions are held via telehealth, either via the telephone or the video conference platform, Please review and sign this special information and consent about telehealth. Let me know if you have any questions.

HIPAA Notice

I am legally required to provide you with this notice. Please sign the last page indicating only that I have given you the form.

Release of Information

If you have another clinician with whom I may coordinate your care (for instance, a psychiatrist, or a general physician who is prescribing psychotropic medications like an antidepressant or sleeping medication), please complete these forms.

Credit Card Authorization

While I am providing services through telehealth, I accept debit and credit cards for payment (Mastercard, Visa, or Discover). Unless we have agreed on a different method of payment, please complete this form.