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.

Helpful Forms:

• Practice Policies
• Initial Session Intake Form
• Electronic Communications Policy
• HIPAA Privacy Information

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