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)

Informed Consent for In-Person Services During Covid-19 Public Health Crisis (download) (For the initial evaluation appointment, generally, we meet in person with masks and > 6-foot separation. Subsequent meetings may be virtual via telemedicine platform)

Telemedicine Informed Consent (download)

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

Optional forms that may be helpful at the first appointment include:

Family Tree (download)

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

Mood & Anxiety Scale (download)

Credit Card Form (download))