If you're a new client, please print, review, and sign the following forms prior to your session. If you have any questions concerning the content of any document, please feel free to raise them during the initial meeting. When you arrive for your session please bring the forms, your insurance card, your EAP authorization number (if you have one), and the form of payment you wish to use to cover any fees.
- Statement of Understanding
- Notice of Privacy Practices
- Acknowledgement of Receipt of Notice of Privacy Practices
- Face Sheet
- Telemedicine Informed Consent
- Credit Card Authorization Form
If you would like me to coordinate care with another agency or treatment provider (e.g., psychiatrist, primary care physician), you must first complete a Release of Information to authorize mutual exchange of your private health information. Use the link below to acquire a copy if needed.
Note: To download Adobe Acrobat Reader for free, click here .