If you’re a new client, please complete the ALL of the following forms in advance and bring them to your first therapy session. Couples must have each partner complete their own intake form but can “double up” on all the rest.
Intake Form
Child & Adolescent Intake Form
Agreement for Psychological Services Form
Request for Confidential Handling of Health Information Form
Health Information Privacy Form
Consent to Telehealth form
Practice Termination Form
Confidentiality & Privacy Policy
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
Exceptions include:
Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.
