Blakely Patterson, L.M.F.T.

LICENSED MARRIAGE & FAMILY THERAPIST

Forms & Policies

If you’re a new client, please complete the Client Intake Form and the Limits of Privacy & Cancellation Policy Form, and bring them to your first therapy session.

You may read this online Summary of Privacy Practices, as well as the Limits of Privacy Disclosure established by the Health Insurance Portability and Accountability Act (HIPAA Law) of 1996.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete the Authorization to Disclose Information Form in order to authorize the release of psychotherapy information.

Please call for a free consultation 
to assess your needs… 615-631-4279