If you're a new therapy client, please complete the following forms and bring them to your first therapy session.
- Client Psychotherapy Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
- Authorization to Disclose Information Form
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Note: To download Adobe Acrobat Reader for free, click here .
If you are a facility seeking psychological testing services, please complete the following Psychological Testing Referral
form and fax it to our office at 866-372-5885.
For all individuals requesting psychological testing services, Prior to the date of service, please complete the following forms and bring them to the appointment with you to expedite the process.
- Intake Form
- Consent to treat a Minor (if necessary)
- Provider Selection form (if Medicaid or Medicare consumer)
- Authorization to Release Testing information (if necessary)
- Signed Acknowledgement of HIPPA policies
- BioPsychoSocial Assessment