If you’re a new client, please complete the following forms and bring them to your first therapy session.
- Adult Intake Questionnaire
- Child Intake Questionnaire
- Services Agreement
- Notice of Privacy HIPAA
- Confidential Information
These forms are not necessary for everyone. Your provider will instruct you if you need to fill any of them out.
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.