If you are a new client, please complete the following TWO forms and bring them to our first session. Additionally, if you would like me to coordinate your care with another provider, please complete the THIRD form at the bottom of this page, giving me permission to contact that provide in the future.
Practice Policies/Limits of Confidentiality/Cancellation Policy (please print, complete, and bring with you)
- Patient Notification of Privacy Rights (HIPAA) (please print, complete, and bring with you)
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:
- Authorization to Disclose Information (please complete and bring if you want me to receive/give information to another provider)
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