Forms

Forms

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

Client Intake
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Informed Consent
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Notice Of Privacy Practice
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No Secrets Policy
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Authorization Release
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The No Surprises Act Standard Notice And Consent Document
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Telemental Health Consent
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Payment Coverage Form
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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.