|
If you're a new Adult Psychotherapy client, please print out and complete the following forms and bring them to your first appointment.
-
Adult Intake Form
-
Informed Consent for Therapy
-
Notice Form for HIPAA
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
If you are the parent of a child coming in for Psychotherapy, please print out and complete the following forms and bring them in to the first appointment:
-
Child Intake Form
-
Parents' Informed Consent
-
Notice Form for HIPAA
Forms for Neurofeedback Training (to be completed in addition to above forms):
-
Adult Informed Consent for Neurofeedback
-
Parents' Informed Consent for Neurofeedback
Note: To download Adobe Acrobat Reader for free, click here.
|
