Forms
Click to open Adobe formatted forms to complete and bring to your first appointment with me, along with your insurance card.
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For Adults Only
- Practice Disclosure and Consent for Treatment
- Intake Information Forms for Adults
- History and Concerns Self Report
- Insurance Information Form (only if you plan to use insurance)
- Self-Pay Financial Agreement (only if you will not be using insurance).
OR
For Kids/Teens Only
- Practice Disclosure and Consent for Treatment
- Parent-Child Agreement for Child/Adolescent Treatment
- Intake Information Forms for Children/Adolescents
- Child/Adolescent Self-Report (for child to complete)
- Parent Child/Family Self-Report (for parent to complete)
- Insurance Information Form (only if you plan to use insurance)
- Self-Pay Financial Agreement (only if you will not be using insurance).
OR
May Be Needed in Some Cases
- Authorization to Release Mental Health Records/Information
(if there are provider(s) or family member(s) you want to give me permission to contact or have involved in your treatment regarding mental health issues). - Authorization to Release Substance Abuse Records/Information
(if there are provider(s) or family member(s) you want to give me permission to contact or have involved in your treatment regarding substance abuse issues only).
"If you don't like something, change it; if you can't change it, change the way you think about it "
