Forms

Here you will find useful forms.

You may want to see them before your initial visit. Feel free to fill out the starred forms (*) before our visit, although we can also do this together in the office.

The Receipt for Professional Services has all the information your insurance company might want if you would like to check with them about being reimbursed for the cost of therapy.

The Intake Form* requests very basic information we will need for our work together.

Consent for Services* is a form that gives detail about the logistics of your and my agreement for work together. There are fee specifics and a few other details of interest.

Confidentiality form is an agreement and protection of your confidentiality during and after our work together. There are exceptions to confidentiality listed on the form.

The HIPPA* (Health Insurance Portability and Accountability Act) form follows a US law designed to protect patients’ medical records and other health information provided to health plans, doctors, and other health care providers.

The HIPPA receipt form is proof that you have the HIPPA form and have had a chance to ask any questions you may have about the information.