For Adults
This packet contains all of the forms for clients over the age of 18. Please fill out all pages, 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.
Included in these forms is the notification of privacy rights (HIPAA). 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.
Children & Adolescents
Please fill out all pages, provide as much information as possible, and double check that you have signed every form that requires a signature. Included in these forms is the notification of privacy rights (HIPAA). 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.
The forms include a special form for Separated or Divorced Parents who are sharing responsibility for decision making and payment. If you are not separated or divorced, you do not need to complete that last form.
Other Forms and Documents
Informed Consent for Virtual Counseling
Electronic communications are not completely secure, so there is a risk that your communications with your therapist may not be private. If you desire to proceed with virtual therapy, 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.