Forms

For your first appointment, you must print, read, and sign the first three forms in the list below. Don't forget to bring them with you! I also recommend that you print out the map at the bottom for guidance in getting to your first appointment. All others are for your reference only.

 
 

1. New Client Form - Bring to 1st Appointment

Please fill out all sections of this one-page form. You cannot be treated without signing and bringing this form to your first appointment.

 

2. Policy Agreement - Bring to 1st Appointment

Please read, initial at the bottom of each page, and sign the final page. You cannot be treated without signing and bringing this form to your first appointment.

 

3. Notice of Privacy Practices Consent - Bring to 1st Appointment

Your signature on this consent indicates that you acknowledge receiving my Notice of Privacy Practices (below). You cannot be treated without signing and bringing this form to your first appointment.

 

4. Notice of Privacy Practices (NPP)

For your reference only. Please read it prior to your first appointment. Signing the NPP Consent (above) indicates that you have read this notice. Please click the link below to read the full policy. 

 

5. Cancellation Policy

For your reference only:  I require 24 hours notice for cancellations. If you cancel our appointment with less than 24 hours (even if you call the day before your session), I need to charge you the full fee for your missed session. (Note that this is the amount I would have been paid had I been able to bill your insurance, not just your co-pay or co-insurance.) It is perfectly fine for you call on weekends and at any time of the day to leave a message. Please click the link below to read the full policy. 

 
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6. Snow Policy

For your reference only. I appreciate that we all differ in our comfort level with winter driving, as well as the types of roads and distance we need to travel to get to my office. I rarely cancel appointments due to bad weather because I live so close, but I want you to practice good self-care and only drive when you feel safe. You will not be charged a cancellation fee as long as you notify me in advance of your appointment. Please click the link below to read the full policy. 

 
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7. EBP Methods Consent:

For your reference only. You will only need to read and sign this form if we decide to include EBP methods in your therapy process. I post it here for those interested in learning more about this option for treatment.

 
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8. Map

This map gives directions to my office as well as instructions about where to park and where to wait for your appointment. I recommend printing it and bringing it as a guide to get you to your first appointment.