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.

  1. Client Information
  2. History
  3. Disclosure Statement
  4. Consent To Disclose PHI
  5. Acknowledgement Of Privacy
  6. Disclosure For Telehealth Treatment

Other Forms

HIPAA notice for patient information

Privacy Notice


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.

Release Of Information


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.

Disclosure for Couples