Forms

New Client Form:


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

INTAKE FORM (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 off 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 / Divorce - Child Therapy Agreement Form: 


This form is only intended for divorced parents (or parents in the process of divorcing) seeking individual therapy for their child, when there continues to be a high level of parental disagreement or conflict between both parents. 

Divorced Parents in Conflict; Child Therapy Agreement Form (pdf)

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