A therapist is legally prohibited from disclosing any information about a client without that client’s explicit permission. The only exceptions are the therapist believes that the client is a danger to him/herself or to others, or if the therapist has a reasonable suspicion of abuse of a child under 18 years old or a vulnerable adult.
Please see the full notice of privacy practices here.
If you’re a new client, you will need to fill out and sign the following forms. Please do not fill them out until you have been instructed to do so. You can fill them out in any of the following ways:
- Download them here, fill them out, and bring them to the office
- Download them, fill them out (digitally or by hand), scan, and send them back to email@example.com.
Please note that e-mail is not a perfectly confidential means of communication. There is a chance that these files could be exposed to unknown third parties on the Internet. They may also be exposed to people in your home or, if you are using your work e-mail, your employer. Please take these facts into consideration before choosing this option. See Consent to Treatment form for more information.
- Fill them out by hand in the office.
To read before signing:
To fill out and sign:
The following forms do not need to be filled out unless you are specifically asked to do so by your therapist:
In order for me to communicate with other relevant parties (for example, your psychiatrist, primary care physician, school guidance counselor, etc.), I will need you to complete and sign this form to authorize me to release your/your child’s information:
- Authorization for Release of Confidential Information
- Authorization for Release of Confidential Information of a Minor
Note: To download Adobe Acrobat Reader for free, click here.
Family conflict is a part of life. There is no family without some level of discord and disagreement. And most families survive intact despite it. However, in some families the level of conflict is elevated to the point where relationships begin to fall apart and the family’s existence as a unit is in question. Sometimes […]
Crummy things happen. They happen to you, they happen to me, they happen to everyone. You may feel you get more than your share of them. But nobody is spared the aggravations of daily life – getting cut off on the road, dealing with a surly customer service rep, finding you were given the wrong […]
One of the important components of anger management is getting an understanding of where your anger is coming from so that you can work towards not only managing your anger when it comes up but also keeping it from boiling over in the first place. Often the reason we get angry is due to our […]
Raffi led an informal group which I attended along with a few classmates from Israel in the summer of 2010. We had just returned to New Jersey from studying in a one- to two-year fellowship abroad. Ra
Highly professional but down to earth. Both my husband and I felt completely understood and valued; something couple’s often fear simply cannot be achieved. I’m sure we’ll return we need a “tu
Raffi made me enjoy going to therapy. I have learned to talk through issues that seemed impossible and I feel so much better about the communication in my relation
My boyfriend and I see Raffi and it was the best decision we ever made. It is hard to gather the right words to describe him and how much he has helped us and our
Caitlin is so special. She is an excellent listener and offers valuable and practical advice for improving life circumstances. I would highly recommend her to anyone looking to grow and improve their