Intake Forms 

Please download, print, and fill out the following forms and then bring them with you to your first appointment. (They are in pdf format.)

Health Insurance Portability and Accountability Act (HIPAA) (download)

Patient Information (download)

Telemedicine Informed Consent (download)

Authorization for Release of Information with your chosen professionals (download)

Family Tree (download)

Bullet-Point List of All Treatments and Strategies Attempted to Date (download)

Mood & Anxiety Scale (download)

Credit Card Form (download)