Helpful Forms

For new clients, please print, fill out, and bring INTAKE to your first session. Also, be sure to read COVID STATEMENT and CLIENT INFORMED CONSENT. We will go over privacy, billing, etc., in greater detail and sign forms at your session.
CLICK ON the bold capitalized title of document to make it pop up.

**CLIENT INTAKE FORM Information about you. 

**My COVID STATEMENT for everyone to read, agree to, and sign (including me!)

**CLIENT INFORMED CONSENT This is helpful information for you. It explains what to expect in therapy and who attends, financial policy, cancellations, privacy, coordinating with other providers, mandating reporting, and my background. 

**SIGNATURE OF AGREEMENT to be signed after reading Informed Consent and discussing privacy, coverage, and payment.

**AUTHORIZATION TO RELEASE INSURANCE INFORMATION If using insurance, this allows me to send billing information to your insurance company and receive payment from them.

TELETHERAPY INFORMED CONSENT for face-to-face TeleTherapy from my private confidential office to your home by appointment only. Teletherapy is covered by most insurance companies during the new era of COVID19 safety. It’s easy! Make an appointment, I send you my doxy.me internet link, you find a private spot to meet with your laptop (ideally) or handheld device with camera so I can see you. Doxy.me software has the highest rating for confidential secure teletherapy.

If you would like me to coordinate care with another provider (former therapist, psychiatrist, primary care doctor, teacher, county worker, etc.), complete the CLIENT RELEASE OF INFORMATION form to authorize release and/or to obtain certain information about your care and health.  I cannot talk, email, or communicate information about you with anyone unless I have a release of information form signed by you or your parent/guardian.

This says everything and more about how privacy is protected: PRIVACY PRACTICES