New Client Intake Forms
Please fill out the following forms prior to your initial consultation
The Client Information Form collects essential details such as your address, contact information, and employment status. It also includes sections for your family history, education background, and psychological history. Additionally, we ask about your current reasons for seeking therapy to better understand your need
The Notice of Privacy Practices outlines how your personal health information will be used and protected. It explains your rights regarding your information, including how it may be shared and how you can access or request changes to your records. By signing this document, you acknowledge your understanding of these privacy practices.
Informed Consent or a Statement of Understanding outlines the nature of the therapeutic relationship, including consent for care. It provides information about confidentiality, the limits of privacy, potential risks and benefits of treatment, explains the costs associated with therapy, and details the cancellation policy. By signing this document, you acknowledge that you understand the terms of therapy, including fees and cancellation requirements, and consent to the treatment process."
A Release of Information form grants permission for the psychologist to share your confidential information with a specified individuals or organizations, such as an individual therapist, when necessary. It outlines what information may be shared, with whom, and for what purpose. By signing this document, you authorize the release of your information as specified. Please complete this form only if needed.