Forms

Listed below are forms intended to provide you with the information you need to make an informed decision about moving forward with me and my services as well as to gather more information about you and your concerns.

Prior to our intial intake appointment, please print and complete the following forms:

  • Psychological Services Agreement
  • Privacy Policies (HIPAA)
  • Demographic Form
  • Intake Information Form (Clients for Testing Only)

 

Other forms that may be helpful to you and your treatment include: 1) Out of Network Benefits (a guide to understanding and using this branch of your coverage) and 2) Release of Information Form

PDF icon Psychological Services Agreement
PDF icon Privacy Policies (HIPAA)
PDF icon Demographic Form
PDF icon Intake Information Form (Clients for Testing Only)
PDF icon Out of Network Benefits
PDF icon Release of Information Form