Intake Forms 

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

Patient Information (download)

Health Insurance Portability and Accountability Act (HIPAA) (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)

Mood & Anxiety Scale (download)

Credit Card form (download))