Forms for Psychotherapy Services

Please print and complete these forms and bring them to your first appointment.  We will review them together and I can answer any questions at that time.

Release of Information: Please print and complete a release form for any person you believe it would be beneficial for me to speak with to best assist you with your concerns. It may be helpful to sign a release form for a physician who is prescribing medications for you, a treatment program you have been in, other mental health professionals involved in your care, etc.

Release Form

Privacy Considerations: Privacy protection is important and I have a duty to uphold your protected health information.  Please download and review information related to the risks with electronic communication and payment to determine if those risks are acceptable to you as related to our communications and payment options.

Communications Information: Disclosure and Risk

Policy on: Communications: routine & urgent

Consent Form to allow electronic communications: email, text, or card processing please fill out this form.

Consent Form: Email,Text, Cards

My HIPAA privacy notice is available for you to read.  You do not need to bring a copy of it with you to your appointment.  I am happy to answer any questions you may have about it.