Forms

It is extremely helpful if you review all the opening paperwork on your own prior to the session (this saves you time during the session).  If you would like to wait until your first session, it will take time off the front end of the session.  You are welcome to arrive early and fill the forms out in the waiting room before the start of your session.

 

Please read over it carefully and jot down any questions that you might have so we can discuss them.

 

Your signature on the forms indicates you have read the information and that it is a binding agreement between us during the course of your therapy.

 

All New Clients: Please PRINT and complete the following forms:

 

1. Client Rights and Services Contract Please complete this contract, it is long and legalese, I apologize for the wordiness and I am happy to answer any questions in your first session.

2. Confidential Information Form This is an assessment that must be filled out by all clients billing insurance and is optional for self pay clients.  When you fill it out, it will be a great help in my formulation of the most efficient treatment plan – it helps me to assess the needs from multiple levels

 

Clients using the Sliding Scale: Please also PRINT and complete the following form:

3. Sliding Scale Worksheet If you are taking advantage of the sliding scale, you are required to fill out this form.  If you are paying full fee you do not need to complete this form.

 

All Clients: Please REVIEW the following forms:

4. HIPPA Notice of Privacy Practices Please review your rights – you do not need to print if you do not want to.  You will sign off that you received these rights in item 1.

5. Release of Information If you would like me to communicate with another therapist/doctor/psychiatrist/loved one/etc.  Please fill out item 6 for each doctor/teacher you would like me to coordinate care with.  If you do not wish me to communicate with them at this time you do not need to complete this form, it can always been filled in later.