If you are a new client, please print and complete the following forms and bring them to your first therapy session:
- Registration Form: /userfiles/2442060/file/Registration Form.pdf
- Outpatient Services Contract: /userfiles/2442060/file/Outpatient Services Contract 01_01_2017.pdf
- Financial Agreement/Insurance Contract: /userfiles/2442060/file/Financial Agreement Insurance Contract 11_2015.pdf
- For adult patients complete this clinical packet: /userfiles/2442060/file/CCA Adult.pdf
- For patients under the age of 18, parent/guardian complete this clinical packet: /userfiles/2442060/file/CCA-Child 01_18_2017.pdf
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 psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here.