Forms

For your first visit, read and complete the Client Registration and Agreement for Psychological Services forms. Please also read the Notice of Privacy Practices. This is for your information but I will need a signed copy of page 8 so that I know you read and understood your rights. If you are planning on using insurance to help pay for your sessions, please complete the Insurance Verification form.
We will go over all three forms during our initial session, so you may ask any questions you have at that time.

Patient Registration
Agreement for
Psychological Services
Notice of Privacy Practices
Insurance Verification

The Authorization to Release Confidential Records and Information form is what we use to obtain your permission to speak to other people about you or your family. It is not necessary to bring to this form to counseling sessions unless you would like for us to talk to another person (e.g., healthcare professional, educator, family member) with whom you wish us to share therapy information.

Authorization to Release Confidential Records and Information

The forms available here are in PDF format. They require Acrobat Reader to view them.
If you do not have Acrobat Reader, download it here for FREE.