New Client Forms

If you’ll print out, read, and complete these New Client Forms before your first appointment, you’ll be saving precious moments we can then use to begin your journey!

Use these if you are a new client:

• Client Information Summary
•      (Complete with personal information –> Sign, date)
• Professional Disclosure
•      (Print 2 and keep 1 for your own files –> Sign, date only)
• Supplemental Confidentiality Letter
•      (Print 2 and keep 1 for your own files –> Sign, date only)
• Records Privacy Notice
•      (Print 2  and keep 1 for your own files –> Sign, date only)
• Release for Electronic Messaging
•      (Complete, sign, date –> keep 2nd page for your files)
• Release for Online Treatment
•        (Complete, sign, date –> keep 2nd page for your files)

Use these only if you have special needs or history:

• Release for Emergency Consults
•      (Complete, sign, date –> keep 2nd page for your files)
• Release For Medical Records
•      (Complete, sign, date –> keep 2nd page for your files)
• Release for Psychotherapy Notes Only
•      (Complete, sign, date –> keep 2nd page for your files)

Use these if care is to be provided to a minor:

• Minors – Consent to Treat
•      (Print 2  and keep 1 for your own files –> Sign, date only)
• Minors — Confidentiality Agreement
•     (Print 2  and keep 1 for your own files –> Sign, date only)