Helpful Forms

The following forms contain information about office practices and your rights regarding your involvement in psychotherapy. Please read through them and prepare any questions you may have about this information so that we may discuss it at our meeting. Retain a copy of these forms for future reference.

 

• Therapy Information

• Therapy Information (Adolescent)

• HIPPA

Next, please complete the Patient Information and Checklist of Concerns forms and bring them to your first session. This information will allow me to begin to understand you and what you are experiencing, and what you would like to achieve through therapy.

FOR ADULTS:

• Patient Information

• Adult Checklist of Concerns

FOR PATIENTS UNDER 18 YEARS OF AGE:

• Patient Information

Adolescent Information Addendum

• Adult Checklist of Concerns

• Child Checklist of Characteristics (for patients under 18 years of age please complete this form and the Adult Checklist of Concerns)

If you are authorizing me to obtain or release any information to another professional (e.g., your PCP, a prior mental health professional, your attorney) please complete the following form.

• Authorization to Release Information

Thank you for your time in preparation of these forms. I am looking forward to working with you.

Note: To download Adobe Acrobat Reader for free, click here .