For Adults
This packet contains all of the forms for clients over the age of 18. Please fill out all pages, and provide as much information as possible, and double check that you have signed every form that requires a signature. If you are seeking couples therapy, or family therapy, everyone coming in will need fill out these forms.
You may download and read the notification of privacy rights here, this notice describes how your mental health records may be used and disclosed and how you can get access to this information. Please read all forms carefully before signing.
Children & Adolescents
Please fill out all pages, and provide as much information as possible, and double check that you have signed every form that requires a signature. You may download and read the notification of privacy rights here, this notice describes how your mental health records may be used and disclosed and how you can get access to this information. Please read all forms carefully before signing.
There are several different packets of forms relating to the age of the client, as well as the marital status of the client's parents. Please use the packet that matches your situation.
Other Forms and Documents
Informed Consent for Internet Counseling
Internet-based Electronic communications are not completely secure so there is risk of your communications with your therapist not being private. If you desire to proceed with therapy using Skype or other Internet-based system, then please click on the link to the right for the informed consent form.
Notification of Privacy Rights
This document contains a notification of your rights under the Health Insurance Portability and Accountability Act (HIPPA). This notice describes how your mental health records may be used and disclosed and how you can get access to this information. please read it carefully. You only need to print and sign
Release of Information
From time to time you may need to sign a release of information to authorize your therapist to exchange confidential information with other providers or individuals for your benefit, or for coordination of care. You will find that document here.
Session Recording Form
This form gives your permission for practicum students, interns, and therapists working toward their license to audio/video record the sessions for supervision.