Intake Forms (all 3 required for 1st appointment)
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Acknowledgement of Privacy Practices (required)
(31K)Prior to signing this form, please review the Privacy Practices which is posted on this website at the page titled Notice of Privacy. Note: this form (signed) is required for initial appointment. -

Informed Consent-Outpatient Contract.rtf
(171K)Please, review the "contract/consent" document; it describes the terms of therapy. Please, print out the Signature page (at the end of the document). Please, note that there are two different Signature pages: one - if you are going to pay for therapy out of pocket, and the other - if you are going to use your insurance. Print out the Signature page that applies. If you don't have a printer or do not wish to print, I'll provide you with the forms at the office. Thank you. -

intakequestionnaire.doc
(30K)Intake Questionnaire (background information, insurance information, etc.). If you are unable to download/open this .doc file, try the Intake Questionnaire file below (in .docx format). Note: required for initial appointment. Thank you. -

questionnaire.docx
(15K)Intake Questionnaire (background information, insurance information, etc.). If you are unable to download/open this .docx file, try the Intake Questionnaire file below (in .doc format). If you are still unable to open/download any of these documents, let me know and I will provide you with a print copy on the day of the initial meeting. Thank you.






