Forms

Forms

Here are my forms which you can download, print, fill out and bring to your appointment:

Client Intake
Select
Informed Consent
Select
Notice Of Privacy Practice
Select
No Secrets Policy
Select
Coaching Agreement
Select
Authorization Release
Select

Please note:
  • I will need a separate release of information for each person who you choose to be involved in your treatment (ex. family member(s), close friend, Psychiatrist, PCP, Neurologist, IOP therapist, pain mgmt Dr, ¬†etc.)
  • The No Secrets Policy is for couples and families only.
  • The coaching agreement is for individuals who are requesting coaching services only.