1. Consent for treatment
This form outlines the policies and procedures regarding most aspects of my practice. By signing this form you are consenting to these policies and to our working together.
Click here to download.
2. Disclosure Statement
This form explains my credentials, your rights as a client and the exceptions to client/therapist confidentiality.
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3. Intake Form
This form captures personal information, mental health and family history.
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4. Credit Card Payment Form
This form is an authorization to keep your credit card on file through my payment system – Ivy Pay.
Click here to download.
5. HIPPA – Notice of Privacy Rights
This document describes how medical (including mental health) information about you may be used and disclosed. This form is for your information only.