Once you have scheduled an initial appointment with me, please download and print the first three forms below (Intake Information, Disclosure Statement, Client Responsibilities and Fees), fill them out and sign them, and bring them with you to our first session.

Please also bring your health insurance card to our first session. If you are certain that your health insurance requires only a copayment, you may pay that amount up front. Otherwise, you are responsible to pay the insurance’s allowed amount per session, or my regular fee per session if you do not have or wish to use insurance. Please be prepared to pay by check or cash.

The fourth form, the HIPAA Notice of Privacy Practices, is for your information only and does not need to be printed.

The fifth form, Authorization for Release of Information, may be used if it would be useful for me to coordinate care with another treatment provider, and/or if it would be helpful in your treatment that I have information from a previous counselor or treatment provider.

Intake Information

Click to download. Complete this form after you have set up an initial appointment with me.

Disclosure Statement

Click to download. You will need to complete this form as well prior to our appointment.

Client Responsibilities and Fees

Click to download. This also needs to be completed and brought to our first appointment.

HIPAA Notice of Privacy Practices

You can click to download and read this form, but it does not need to be printed.

Authorization for Release of Information

If you want information shared with another provider, click to download and fill out this form.