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Forms

 

If you're a new client, please complete the following forms and bring them to your first therapy session.

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Client Psychotherapy Intake Form

 

Limits of Confidentiality/Therapy Cancellation Policy

 

 If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

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Authorization to Disclose Information Form

Authorization for Use or Disclosure of Protected Health Information

Client Information

Recipient Information

Thanks for submitting!

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