Paperwork

Please note, depending on insurance and what we have discussed over phone/email, not all paperwork may need to be completed. However, all new clients are required to complete the Disclosure and Consent Form, The Credit Card Authorization form and the Mental Health and History Symptoms Form.

Disclosure and Consent
DisclosureConsent.pdf
178 KB
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Release of Information
ReleaseOfInformation.pdf
184 KB
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Credit Card Authorization
CreditCard.pdf
177 KB
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No Surprise Act (for clients paying out-of-pocket or out-of-network)
NoSurpriseAct.pdf
218 KB
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History of Mental Health Symptoms
HistorySymptoms.pdf
187 KB
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You are also welcome to arrive 15 minutes early for your first appointment to fill out the paperwork in person.