Forms

Paperwork, paperwork...
Yes, sometimes its necessary.  Five distinct forms are available here for download so you can complete them in the comfort of your home, before we meet. 
  • Client Information-  Your basic personal information. Required for all clients.
  • Office Policies- The details of our interaction. Required for all clients.
  • Notice of Privacy Practices ("NOPP")- Information for your perusal about my obligations (and limits) on your confidentiality, as mandated by law. 
  • Receipt of NOPP- Your acknowledgment that you've reviewed my privacy practices. Required for all clients.
  • Authorization to Disclose Information- Everything in therapy, including the fact that you are in therapy, is confidential. I can't speak with anyone without your explicit written permission. By completing this form you specify who I can speak to and about what subjects.  The authorization can be revoked if you later change your mind. Common persons you may want me to contact include a child's teacher, a previous therapist or an out-of-town family member. 
client_information-_2013.pdf
File Size: 76 kb
File Type: pdf
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office_policies_2013.pdf
File Size: 78 kb
File Type: pdf
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notice_of_privacy_practices_2013.pdf
File Size: 113 kb
File Type: pdf
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receipt_and_acknowledgement_of_nopp_2013.pdf
File Size: 103 kb
File Type: pdf
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authorization_to_disclose_or_obtain_information_2013.pdf
File Size: 15 kb
File Type: pdf
Download File