Helpful Forms

INDIVIDUAL THERAPY

• New Client Registration Form
• Consent to Assessment and Treatment Form
• Authorization for a Reminder
• Consent to use Teletherapy

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

• Authorization to Disclose Form

COUPLES THERAPY  (Print out one of each of the forms.  Both partners will need to sign the Registration Form and the Consent to Assessment and Treatment)

• New Couple Registration Form
• Consent to Assessment and Treatment Form for Couple
• Authorization for a Reminder
• Consent to use Teletherapy for Couple

If you would like me to coordinate care with another provider (for example, your psychiatrist, previous therapist, primary care physician, etc.), complete this form to authorize release of psychotherapy information.  Both partners must complete and sign their own form for each provider.

• Authorization to Disclose Form

 Important information:  Please read to be informed, you do not need to print

• Limits to Confidentiality (AZ Notice of Privacy Practices)
• No Surprises Act (Good Faith Estimate)

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