FORMS FOR THERAPY …..
Below are some important documents for you to take a look at concerning your rights as a therapy client. The first form is an intake questionnaire for you to fill out, which will help me better understand how I can be of help to you. The second form is a therapy agreement, that clearly outlines our professional relationship. The last three are documents regarding your rights as a client, your confidentiality, as well as privacy practices. I’ve also included a document that includes my office location and directions. If you have any questions regarding any of these forms, please don’t hesitate to contact me.
INSTRUCTIONS Please print out document #1 and #2 (Intake Form and Therapy Agreement) and follow directions below. The rest of the documents are for your information, so no need to print them unless you prefer to. If you are unable to print the first two documents, please let me know. You will need to come 15 minutes early for your first session to fill out the paperwork at the office, which I’ll leave for you in the waiting room.
- INTAKE FORM Please print, fill out, and bring to our session (2 for couples, 1 per person).
- THERAPY AGREEMENT Print, fill out, and bring to our session (2 for couples, 1 per person).
- CLIENT CONFIDENTIALITY For your information; please read over before our session.
- CLIENT RIGHTS For your information; please read over before our session.
- COMMUNICATIONS POLICY For your information; please read over before our session.
- NOTICE OF PRIVACY PRACTICES HIPAA For your information; please read before our session.
- OFFICE LOCATION For your information; please read over before our session.
OTHER FORMS In order to coordinate care with another provider (e.g., psychiatrist, couples or individual therapist, primary care physician, etc) and give you the best care possible, please complete this form to authorize release of mental health and medical information that would be pertinent to our work together:
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