Intake Forms for Therapy

If you’re a new client, you will need to read some terms of service, then fill out and sign the intake forms.  Please do not fill them out until you have been instructed to do so!

To read before signing:

Consent to Treatment

Notice of Privacy Practices

Consent for Telemental Health Services (if you will be having online sessions)

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

Confidentiality & Privacy Policy

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.

Personal Development Coaching

Terms of Service

Intake Form