These are the forms I need for you to complete in order for us to begin our work. Please fill out five of the forms and bring them in to your first session: Client Information, History, Disclosure for Treatment, Consent To Disclose PHI, and Acknowledgement Of Privacy Form.
- Client Information
- Disclosure Statement
- Consent To Disclose PHI
- Acknowledgement Of Privacy
- Disclosure For Telehealth Treatment
HIPAA notice for patient information
If you have seen a prior therapist, a psychiatrist, or if you have a primary care physician, please complete the Release of Information form so I can contact them.
If you will be coming as a couple, both of you will need to sign the form below in order for me to treat you.