Intake Forms

Please choose the appropriate form below and print it and fill out before your initial appointment. Bring a hard copy with you and you will sign it at the start of the session to acknowledge the legal and policy agreements of the therapeutic contract.

 

Professional Disclosure Statement

 

HIPAA Privacy Statement

 

Adult Intake

 

Teen Intake

 

Consent: Telehealth

 

Authorization to Release Information

 

Credit Card Authorization Form