REQUIRED FORMS
Below are forms that you will need to bring to your first session. Please print all forms and fill them out prior to coming to the office. A “Client Intake Form” will need to be printed for EACH person attending therapy. The “Informed Consent for Treatment,” “Notice of Privacy Practices,” and “Office Safety Informed Consent for Treatment” only require you to print the signature pages and all parties can sign one copy. The “Fee Agreement” also needs to be printed and signed by all parties attending therapy.
Please read each form carefully, as much of this information speaks to your rights and responsibilities as a client and my responsibilities as your therapist. As well, fees, cancellation policy, office safety, and how your information is handled and protected are all outlined. It is in your best interest to read and understand these forms. Please feel free to contact me should you have ANY questions or concerns prior to signing anything. This will help establish our therapeutic relationship on the right foot with clear and consistent information.
Informed Consent for Treatment
Office Safety Informed Consent for Treatment
OPTIONAL FORMS
If you would like me to coordinate care with another provider (i.e., your psychiatrist, primary care physician, former therapist, etc.), please complete the below form, “Authorization to Release Information,” to authorize me to release and/or obtain information regarding your treatment. In the case of couples or family therapy, all participants need to sign this form for me to proceed with your request:
Authorization To Release Information
If you choose to participate in hypnotherapy, please read and sign the form below and bring it with you to your session.