If you're a new client, please complete the following forms and bring them to your first therapy session.
- Client Intake Form
- Informed Consent to Treatment Form
- PA Notice Form for HIPPA
- Telehealth - Informed Consent to Treatment Form
- EMDR - Consent to Treatment Form
- Insurance Verification Form
- Child Intake Form
- Child - Informed Consent to Treatment Form
- Adolescent Minor Consent to Treatment Info
Note: If you wish to email the fillable forms to me, please choose: File - Save as and add your Name or Initials to the document after typing in your information and prior to emailing the form back to me (or the information you typed in will not save). Thank you.
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here.