CLIENT PACKET

Demographics Form

Confidentiality Policy

Treatment Fee Agreement

Adult Intake Form OR Child Intake Form

Fee for Service form is for clients who are self-pay and will receive a receipt for services.

Insurance Fee Agreement form is for clients who will be using their insurance for payment.

Any adjustments to fees and co-pay fees can be addressed when you come to the first appointment.

Forms

All Clients Please print, complete and sign the CLIENT PACKET

Clients using insurance please complete the following forms:

Insurance Form

Insurance Fee Agreement Form

READ ONLY

No need to Print - Credentials and Treatment Agreement​

Please bring the completed forms to your first visit. Completing the forms prior to your visit will enable us to have more time to talk during your first visit. You can also choose to complete the forms at the time of your visit.

OTHER FORMS

Consent to Use Electronic Methods in Therapy

Authorization to Release Information

Authorization to Inspect Copy of Records