Client Forms

If you're a new client, please review "Informed Consent" and "HIPAA Notice of Policies and Procedures"- these are for you to keep. Please print out and complete the "Client Information", "Background Information", "Consent Acknowledgment for Treatment", "Client Acknowledgment of HIPAA", and "Payment Authorization" forms and bring them with you to your initial consultation appointment. These forms will go into your treatment file of record.

• Client Information
• Background Information
• Informed Consent
• Consent Acknowledgment for Treatment of an Adult
• HIPAA Notice of Policies and Procedures
• Client Acknowledgment of HIPAA Notice
• Payment Authorization

If you would like me to consult with and coordinate care with another provider (e.g. your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information. Please use a separate form for each person with whom you would like me to consult and coordinate care.

• Release of Information Authorization Form

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