Unless otherwise noted, all forms are necessary to commence therapy
        Please bring them completed to our first session

CONFIDENTIAL CLIENT INFO

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Please download this form, fill it out, and bring it with you to our first meeting.
This is part of the New Client Paperwork.

FINANCIAL AGREEMENT FORM

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Please download this form, fill it out, and bring it with you to our first meeting.
This is part of the New Client Paperwork.

CONSENT FOR TREATMENT

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 Please download this form, fill it out, and bring it with you to our first meeting.
This is part of the New Client Paperwork. 

CREDIT CARD AUTHORIZATION FORM

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Please download this form, fill it out, and bring it with you to our first meeting.
This is part of the New Client Paperwork.

HEALTH INSURANCE PORTABILITY & ACCOUNTABILITY ACT (HIPAA) NOTICE OF PRIVACY PRACTICES FORM

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Please download this form, fill it out, and bring it with you to our first meeting.
This is part of the New Client Paperwork.

CANCELLATION POLICY

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Our weekly appointment time is reserved specifically for you and will not be offered to anyone else seeking treatment.

 

 

These forms are optional; please complete where appropriate

 

INSURANCE CLAUSE FORM

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If you would like to utilize your insurance benefits or require a Super Bill, please complete this form.

CONSENT TO RELEASE INFORMATION

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If you would like me to speak to your psychiatrist, family member or anyone else about any part of your treatment, please complete this form.

CONSENT FOR TELEMEDICINE

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If you would like to participate in sessions over the telephone or Skype, please complete this form before our first telemedicine session.