Forms

Your First Appointment

Your first appointment will be an intake session lasting 60 minutes unless otherwise specified. In some cases, the intake may be 90 minutes for

families with teenagers. Please download the forms below and bring them to your first session. If you are an adult over the age of 18, please complete the Adult Intake forms and bring them with you.

If the appointment is for your child, please complete the Child Intake forms and bring them with you. Please do not bring your child to the intake session. It is important for parents to be able to talk privately about their concerns without the child present. If you are divorcing or are divorced, you must bring the section of the divorce decree outling who can authorized health care.

Child and Adolescent Intake Forms

• 1.Child Intake Questionnaire
• 2. Consent for Treatment Form
• 3. Authorization to Disclose Information Form so that I can coordinate care with your child's pediatrician and/or teachers, if necessary.
• 4. Notice of Privacy Practices Please review this information and keep a copy for your records. Sign and Return the below form confirming you understand the Privacy Practices.
  • Acknowledgement
• 5. Custody Dispute Contract
• 6. Right to Seek Mental Health Treatment Form

Adult Intake Forms 

• 1. Adult Intake Questionnaire 
• 2. Consent for Treatment Form
• 3. Authorization to Disclose Information Form to coordinate care with your physician.
• 4. Notice of Privacy Practices Please review this information and keep a copy for your records.
  •  Acknowledgement

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