If you’re a new client, please follow instructions in sections A, B and C and complete the forms and bring them to your first session or let us know when you are ready to fax them.
For psychotherapy, please print and complete the following forms:
- Anxiety and Depression Client Info
- Anxiety and Depression Informed Consent
- Emotional Eating Client Info
- Emotional Eating Informed Consent
For nutrition therapy, please print and complete the following forms:
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form for each healthcare provider you authorize me to release information to:
Please read the HIPPA Policies and sign the Acknowledgement form and Breach of PHI form listed below.
- Notice of Privacy Practices Receipt and Acknowledgment of Notice
- Contact by Telephone/Verbally in Event of Breach of PHI
- HIPPA Policies
Thank you. You can bring the signed forms to the first session or fax them before you attend Completing this first step before we meet will help us to spend more time discussing the issues you are struggling with during our first session.