Psychotherapy Intake Form

Please print, fill out this form and bring it to our first session. This will give me a chance to know you and your goals better

Client Release of Information

Please print, and fill out this form, if you wish to allow me to discuss any information with a third part

Client Credit Card Form

Cash, check, and credit cards are accepted as methods of payment. Please print, and fill out this form if you will be paying by credit card

Consent to Treat Minors

Please print and fill out this form if I will be treating someone under your care who is less than eighteen years of age.

Couples Assessment

When prompted by myself, please print and fill out this form as an aid to assist me in evaluating your relationship

No Suicide Contract

Please complete this form, when prompted as a sometimes important tool for life.

ACKNOWLEDGEMENT OF RECEIPT OF PRIVACY PRACTICES

Please print and sign this form prior to our introductory session.

Addict Release of Information

Type a description of the project, client, or activity. Change the picture to one of your own, such as a picture of the project

Complete Client Intake Form

Type a description of the project, client, or activity. Change the picture to one of your own, such as a picture of the project

Client Signature Page

Type a description of the project, client, or activity. Change the picture to one of your own, such as a picture of the project.