Please complete each of the forms below.

These forms are required for your first session.

Copayments or Coinsurance payments are due at time of visit.

Payments can be made by either a Check or Cash payment.

Thank you.

• Patient Intake Form

(Please print these forms and complete.  Bring to your first session)

• Patient Authorization Form

(Please print this form and complete.  Bring to your first session.)

• Patient Intake Questionnaire

(Please print this questionnaire in as much detail as possible.  There are questions that do not apply to you.  You can skip those.  Bring this form to your first session.)

• Making Change Possible

(Please print this form and complete.  Bring to your first session.)

• Relationship Satisfaction Questionnaire

Please complete this form if you are coming for marriage/couples therapy.

• Release of Information

(Please print this form and complete.  Bring to your first session.)

• Informed Consent and Confidentiality Practices

(Please print this form and complete.)

• Authorization for Mental Health Treatment

(Please print this form and complete.)

• Beck Depression Inventory

Please circle the number corresponding to how you feel at this time. These forms are to be completed and brought with you to your first session.

• Patient Health Questionnaire

Please circle the number corresponding to how you feel at this time. These forms are to be completed and brought with you to your first session.

• Notice of Privacy Practices