Intake Forms
I have all required forms available to be signed electronically. When you schedule your initial appointment with me, I will send a link to you that will provide you access to my client portal. From there you can review each form, fill them out, and sign them electronically. This will save time during our first session. It will also minimize contact for the COVID-19 social distancing.

If you choose not to sign electronically, you can find links to the forms below. The forms are in PDF format and require PDF file reader software (such as Acrobat). If you unable to access these forms please contact me, and I will send them to you either by e-mail or through the postal service. *Please note: Electronic signing is required for Telehealth during the COVID-19 social distancing period.

Please complete each of the 4 forms below and bring them with you to your first appointment.

  1. Individual Intake Form
    The individual client intake form provides me with contact information, a general history, and other necessary information to provide the best care for you.

  2. Informed Consent Form and Informed Consent Packet
    This packet provides the policies for confidentiality policy, fees, appointments and treatment consent. The form related to the packet is the agreement for consent of services and acknowledgment of receipt of the packet. You only need to bring the form with you, the packet is for you to keep.

  3. Professional Disclosure Statement
    A basic description of my practice, philosophy, education, fees, and your rights as a client. This is a double sided form. Please sign the back of the form.

  4. Fee Agreement Form

    This form includes payment information and insurance billing information, if needed. It is a double sided form. Please fill it out and sign at the bottom on the second side of the form.

The following forms are used as needed, and are not necessary for the initial session unless we discussed otherwise.

Release of Information Form
Consent form needed for communication with other authorized providers, professionals, or people in your life. I can only share information with others with your written permission given through this form, except when indicated otherwise by law.