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Woman Smiling
Woman Smiling

Forms and Privacy

If you're a new client, please complete the following forms and bring them to your first therapy session.


If you would like us to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:



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 dependant adult or elder abuse, for which we are required by law to report this to the appropriate authorities immediately.
  • If a client is threatening serious bodily harm to another person/s, we must notify the police and inform the intended victim.
  • If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in insuring their safety. If they do not cooperate, we will take further measures without their permission that are provided to me by law in order to ensure their safety.






     

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.

Helpful Forms

Click here to view and print forms for your appointment.

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