New Client Forms
Please download and complete these forms prior to our first session. All of the forms require your review and signature.
New Client Intake Form
This document asks for information about your history, current situation, and counseling goals.
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Treatment Contract
This document is an agreement which contains information about my professional services & policies for counseling services.
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Notice of Privacy Practice (HIPPA)
This document explains the rules established as national standards to protect your health information and your privacy.
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Credit Card Authorization Form
If you wish to pay by credit card, please complete this form to authorize automatic credit card payments for counseling sessions.
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Authorization of Release of PHI
This form authorizes me to release protected health information (“PHI”) from your clinical record to the person you designate.
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