For your convenience, you will find all of the forms needed by clicking on the titles below. Please print, read and complete all of the forms appropriate to the client’s age (or circumstance for group therapy and collaborative divorce cases) prior to our initial meeting. Please bring all completed forms with you to our first appointment.
Once you have decided to enlist my services, I will ask you to provide payment AND all necessary parties will sign the Services Contract and Consent to Treatment form.
For any questions or assistance, please contact me.
→ COVID-19 Forms
Informed Consent Checklist for Telepsychological Services
Informed Consent for In-Person Services During COVID-19 Public Health Crisis
Office Safety Policies – COVID-19
→ Forms for Children
Client Registration Form
Services Contract and Consent to Treatment Form
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement Form
Electronic Media Policies with Patients Form
Child and Adolescent Patient History Form
Symptom and Behavior Checklist – Parents
→ Forms for Adolescents
Client Registration Form
Services Contract and Consent to Treatment Form
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement Form
Electronic Media Policies with Patients Form
Child and Adolescent Patient History Form
Symptom and Behavior Checklist – Parents
Symptom and Behavior Checklist – Adolescents
→ Forms for Adults
Client Registration Form
Services Contract and Consent to Treatment Form
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement Form
Electronic Media Policies with Patients Form
Adult Patient History Form
Symptom and Behavior Checklist – Adults
→ Forms for Group Therapy
Client Registration Form
Services Contract and Consent to Treatment Form
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement Form
Electronic Media Policies with Patients Form
Child and Adolescent Patient History Form
Symptom and Behavior Checklist – Parents
Group Therapy Contract
→ Forms for Collaborative Divorce Process
Collaborative Case Contact Information
Collaborative Divorce Participation Agreement with Addendum A
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement Form
Electronic Media Policies with Patients Form
→ Interpersonal Skills Group Therapy
Client Registration Form
Services Contract and Consent to Treatment Form
Notice of Privacy Practices
Notice of Privacy Practices Acknowledgement Form
Electronic Media Policies with Patients Form
Symptom and Behavior Checklist – Adults
Interpersonal Skills Group Therapy Contract