If you are a new client, follow the directions on the informational email sent to you by our intake staff.  Complete each of the following links under the appropriate service for which you are seeking and appointment. These forms are in addition to and separate from registering on our electronic health records system, Therapy Appointment. Please sign and return them electronically at least 48 hours before your first session.  **If forms are not received, we may have to reschedule the first appointment, as our therapists need time to review in order to best serve you. **

 

ADULT INTAKE:

Adult Intake Packet

 

COUPLES INTAKE FORMS:

Couples Intake Packet

 

ADOLESCENT (12-17 years) INTAKE FORMS - please complete each link:

Adolescent Intake Packet

Adolescent Intake Parent/Guardian Form

Adolescent Checklist of Concerns

 

CHILD (Under 12 years) INTAKE FORMS -please complete each link:

Child Intake Packet

Child Checklist of Concerns

 

CLINICAL SUPERVISION INTAKE

Clinical Supervision Intake Packet

 

OTHER FORMS - as necessary:

Telehealth Consent

Credit Card on File Form

Child Under 14 Consent to Treatment

Special Confidentiality Notice for Parents of Children over 14 yrs

GAD-7

PHQ-9

 

 

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

 

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.