Forms

Please complete all forms before your first visit. 

Disclosure Form for Individual Therapy

Disclosure Form for Couples

Policies-and-Practices (HIPPA) - This notice describes how psychological and medical information about you may be used and disclosed.

Good Faith Estimate of Services

Credit Card Authorization Form - This form gives me the authorization to charge your credit card for your appointments.

Consent to Release Information Form - This form gives me authorization to release confidential mental health information (required only when we must contact other health professionals involved in your care).