Client Forms
If you’re a new client, please complete the following forms and bring them to your first therapy session.
- Client Intake
- Client Rights
- Fee Schedule
- HIPAA Forms
- Good Faith Estimate
- Protection Against Surprise Bills
- Informed Consent and Agreement
- Insurance and Payment Information
- Consent for Telemental Health Sessions
Note: To download Adobe Acrobat Reader for free, click here.
Confidentiality & Privacy Policy
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
Exceptions include:
- Suspected child abuse or dependent adult or elder abuse, for which we are required by law to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person/s, we must notify the police and inform the intended victim.
- If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, we will take further measures without their permission that are provided to us by law in order to ensure their safety.
