Forms

New clients: please print and complete these forms and bring them with you to the first session OR use the free FormSign extension for Chrome to complete them online and send by email. This allows us to save time in the session. If you are unsure about any item, please leave it blank and we will discuss it together.

Adult Clients

1. Medical Authorization
2. Payment Authorization
3. Symptom List
4. Authorization to Videotape Sessions
5. Release of Information (Please complete 1 form for EACH person you want information released to: spouse if couples’ counseling, psychiatrist if under medication, physician for physical pain, your primary or previous therapist, etc.)

Minor Clients

1. Medical Authorization
2. Payment Authorization
3. Symptom List (to be completed by client, not parent)
4. Authorization to Videotape Sessions
5. Release of Information (Please complete 1 form for EACH person you want information released to: psychiatrist if under medication, physician for physical pain, your primary or previous therapist, each parent if you are a teenager, etc.)