Forms for Our Clients

Therapy Forms

Please click on the link below to access the respective form.

Personal Information Form
This form will allow you to provide me with information about you, you current life situation, and your history. A symptom checklist is also included.

HIPAA Notice
This notice describes how psychological and medical information about you may be used and disclosed, as well as how you can get access to this information. It also describes the limitations of the confidential nature of our therapeutic relationship.

Consent to Treatment Form
Your signature on this form indicates that you willingly agree to enter into therapy under the conditions that we agree upon and that you may terminate therapy at any time you choose.

Information for Clients Brochure
This brochure contains important information about our relationship in therapy. After you have read it, we will discuss any questions and concerns that you have. I will then ask you to sign a separate “Consent to Treatment” form indicating that you have read and fully understand the content of this brochure.