Helpful Forms




If you're a new potential client, please complete the following three forms and bring them to your first therapy session.

  • Client Information Form
  • Checklist of Concerns
  • Limits of Confidentiality/Therapy Cancellation Policy
Client Information Form
Limits of Confidentiality/Therapy Cancellation Policy
Checklist of Concerns

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this additional form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form
Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here .

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Helpful Forms

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