Client Forms

For NEW CLIENTS

The following (Steps 1-3) must be completed prior to your first appointment

Step 1: Choose and complete applicable form

New Client Information (Child-Teen under 18)

OR

New Client Information (Individual Adult 18+)

OR

New Client Information (Family/Parenting)

Step 2: Complete

HIPAA Notice and Acknowledgement 

Step 3: Print, complete, and bring to your first appointment

Credit Card Authorization Form

For NEW and EXISTING CLIENTS

The following (Step 4) may be completed at any time, at the request of the therapist

Step 4: SUPPLEMENTAL FORMS

Consent for Telehealth Treatment

TO BE COMPLETED FOR ONLINE (ZOOM) OR REMOTE TREATMENT

Authorization for Release/Exchange of Information 

TO ENABLE COMMUNICATION BETWEEN MY THERAPIST AND OTHER PARTIES IF NECESSARY

Documentation Upload

TO PROVIDE SUPPORTING DOCUMENTATION RELEVANT TO MY THERAPY AND/OR REQUESTED BY MY THERAPIST

(i.e., EVALUATION REPORTS, IEPs, LEGAL DOCUMENTS)