Whatever your distress, please know there is a pathway for healthy growth. Let's work together to find the best way forward
Forms
Start your journey on the road to recovery by filling out the forms below.
HIPAA Notice of Privacy Practices - This form informs you of my responsibilities to protect your healthcare information
Information, authorization, and consent to treatment - This form details what to expect from treatment as well as what is expected in the counselor-client relationship.
Informed Consent Addendum for TeleHealth Therapy - This form details the security and confidentiality of treatment over telephone, video conference, and other distance communication technologies.
Client Information Form—Adult - This form gives you an opportunity to detail your current medical and emotional state as well as personal information that will help guide counseling treatment.
Client Information Form—Adolescent - This form gives the parent and adolescent an opportunity to detail the adolescent’s current medical and emotional state as well as personal information that will help guide counseling treatment.
Consent and Authorization to Release Information - This form is for those who wish for me to consult with other therapists or healthcare providers that you may have with regards to how best to treat the client. Information shared is for the sole purpose of facilitating maximum care to you as the client.
Please read and sign the forms either manually or digitally (for digital signing you can download Adobe Reader for free) and return them to me via my encrypted, HIPPA-compliant contact me page.