Helpful Forms

If you're a new client, please print, complete the following forms and return the forms prior to your initial visit.   Please Note:  There may be a few other documents that will need to be also signed in your first session with me present.  

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 or sign

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

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