Forms

New Client Form:


Save time by printing and completing your intake forms.  Bring the completed forms to your first appointment.

New Client - FULL INTAKE PACKET (pdf)

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As a new client, you must review and understand your client rights:​  Health Insurance Portability and Accountability Act of 1996 (HIPAA)​.
More information can be found on the U.S. Department of Health & Human Services website by CLICKING HERE.  Or you may request a copy at our office.

Release of Information Form:  


Fill this form out if you would like to authorize our office to communicate or exchange information (such as your records) with another office or individual.

Release of Information - ROI (pdf)

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Parents in High Conflict - Child Therapist Agreement


**Important** -  This contract is only required for parents who are either separated / divorced or are in the process of a separation / divorce that continue to be in a high state of conflict or disagreement regarding custody and/or high conflict regarding co-parenting their child together.  As a result, the parents are unable to effectively co-parent their child.  Effective co-parenting means that both parents can communicate in writing AND in person the needs of their child and are both able to implement an agreed parenting plan without regular conflict.  Sure, all parents (even those not separated or divorced) have conflict regarding co-parenting.  This contract applies to those parents where co-parenting conflict is happening most, if not all, the time between parents.  This contract must be agreed upon and signed by both parents in order for individual therapy to start with their child.

Parent Contract - Parents in Conflict (pdf)

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