Reading, Filling out and signing these forms prior to our first session will help us to devote more time to getting to know each other and addressing the reasons that brought you to therapy. Find links to PDF versions of each below.

✓Adult Contact Form

This form is specifically for adult clients. It includes contact information. Please fill out thoroughly.

✓Child Contact Form

This form is specifically for child and family clients. It includes contact information. Parents or guardians, please fill out thoroughly for you and your family.

✓Consent Form

This consent is for all therapy and assessment clients. Please read it carefully, fill in the blanks and have adolescents and adults sign. Please also initial the services to which you are agreeing. By signing the consent, you are agreeing that you’ve read this document and the following three documents. I’m happy to review these agreements and answer any questions when we meet, but it’s helpful if you review them in advance. On this consent, please initial to indicate that you’ve read each of the forms below.

1. ✓Office Policies
   

2. The office policies introduces my office policies and describes some of the consent form in more detail. Please read.
   

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4. ✓HIPAA Privacy Notice
   

5. HIPAA refers to the Health Insurance Portability and Accountability Act established in 1996 that sets guidelines for protected health information and privacy. These are federal guidelines to which all healthcare providers must comply. I am bound by law to provide the information contained. Please read.
   

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7. ✓Social Media Policy
   

8. The Social Media policy lets you know how I handle interactions on the internet: email, social networking, and internet review sites, among others. In an age where most of us use the internet for communications, it is important to clarify policies in order to protect your privacy and maintain confidentiality. Please read.
   

✓Adult Release of Information

If you think it would be helpful for me to talk to other professionals about your care or previous treatment, please print and complete this release for each person to whom you would like me to speak. Your consent to release information can be revoked at any time, and I will get verbal confirmation from you before I actually speak with anyone.

✓Child Release of Information

Work with children has to include the other adults in the child’s life, such as caregivers, teachers, primary care physicians, etc. Please print and complete a form for each person with whom I should speak about your child. I will not contact anyone without your prior verbal approval in addition to this form.