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New Patient Package

If you are a new client, please print and complete the following forms and bring them to your first therapy session:

1.  Registration: /userfiles/2442060/file/Registration Form.pdf

2.  Outpatient Services Contract: /userfiles/2442060/file/Outpatient Services Contract 01_01_2017.pdf

3.  Insurance/Financial Contract: /userfiles/2442060/file/Financial Agreement Insurance Contract 11_2015.pdf

4.  Clinical Packet For Adult Patients: /userfiles/2442060/file/CCA Adult.pdf

5.  Clinical Packet For Patients under the age of 18, parent/guardian complete this clinical packet: /userfiles/2442060/file/CCA-Child  01_18_2017.pdf

6.  Consent For Release of Information: I If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of information: /userfiles/2442060/file/Authorization to Obtain andor Release Information 01_01_2017.pdf


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Helpful Forms

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