“Happiness is not something you postpone for the future; it is something you design for the present.”
– Jim Rohn, Entrepreneur, Author, and Motivational Speaker
If you are a new client, please print and complete the appropriate following forms and bring them to your first scheduled therapy appointment:
For Adult Clients:
- Consent to Treatment
- Notice of Privacy Practices (For you to review.)
- Acknowledgement of Receipt of Privacy Practices
- Intake Form-Adult
For Children/Adolescents:
- Consent to Treatment
- Consent for Treatment of a Minor
- Notice of Privacy Practices (For you to review.)
- Acknowledgement of Receipt of Privacy Practices
- Child Intake Form
*If your child’s parents or legal guardians are divorced, please bring a photocopy of the court decree showing the dissolution of the marriage. If you are unable to make a photocopy, I would be happy to do so during our first appointment.
For All Clients:
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, child’s teacher, etc.), complete the form below to authorize the exchange or release of your psychotherapy information.
For Telemedicine (Videoconferencing)
At this time, I am conducting sessions solely via video. The required consent forms listed above are required in addition to the telemedicine consent form located below.
