FORMS
Paperwork! It's a part of our world.
I am providing my information documents and consent forms here, so that you may come to your first session with them already completed. This preserves our valuable time together to begin talking about your needs.
(However, if you prefer that we go over these together in our initial meeting, I am more than happy to accommodate you. We will need to complete these first before beginning to discuss what brings you into therapy.)
I am providing my information documents and consent forms here, so that you may come to your first session with them already completed. This preserves our valuable time together to begin talking about your needs.
(However, if you prefer that we go over these together in our initial meeting, I am more than happy to accommodate you. We will need to complete these first before beginning to discuss what brings you into therapy.)
Here's how to complete this process, in FIVE easy steps:
1) Download each of these documents:
1) Download each of these documents:
| Outdoor Consent |
| telehealth.pdf |
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OFFICE POLICIES AND INFORMED CONSENT: This document explains my office policies and confirms your agreement to the terms of my psychotherapy services. This includes important information about your confidentiality, as well as my fee and cancellation policies. Please make note of any questions or concerns you have while reading this form so that we may discuss them when we meet. Signature required.
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NOTICE OF PRIVACY PRACTICES: I am required by law to provide you with a copy of the HIPAA Notice of Privacy Practices so you can understand your rights and protections related to the use and disclosure of your identifiable health care information. Signature required.
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SOCIAL MEDIA POLICY: This document explains my policies and procedures regarding my potential interactions with clients on the Internet. Signature required.
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CLIENT INFORMATION FORM: Prior to our first session, please complete my Client Information Form and bring it to our first appointment. This provides me with important details and contact information, while preserving our first session to discuss your needs. Please share only what you are comfortable with, and feel free to leave sections blank.
You may type your responses into the word document provided if desired. You may also use the "Edit Forms" button in my initial scheduling email to fill out a secure electronic version. | ||
2) Read each of them thoroughly, making notes of any questions or areas of concern.
3) Print each of them out. (You may also request that I mail you copies, or that I print them for our first session.)
4) Sign or complete these documents where indicated, which confirms your consent and agreement.
5) Bring these signed documents to session (or read and sign them if I have printed them for you).
I will review them when you arrive to make sure they are complete, and will be sure to check whether you have any questions or concerns about the material. I am happy to provide you with copies of anything you have signed.
NOTE: While you always have the choice to send these completed forms by email, please be aware that email is not a confidential means of communication. There is a chance that these files could be exposed to unknown third parties on the Internet, and that they may also be exposed to people who have access to your computer in your home and workplace. Please take these facts into consideration before emailing these forms to me, and know that I suggest printing these forms and bringing them to my office at our first session.
OPTIONAL FORMS
3) Print each of them out. (You may also request that I mail you copies, or that I print them for our first session.)
4) Sign or complete these documents where indicated, which confirms your consent and agreement.
5) Bring these signed documents to session (or read and sign them if I have printed them for you).
I will review them when you arrive to make sure they are complete, and will be sure to check whether you have any questions or concerns about the material. I am happy to provide you with copies of anything you have signed.
NOTE: While you always have the choice to send these completed forms by email, please be aware that email is not a confidential means of communication. There is a chance that these files could be exposed to unknown third parties on the Internet, and that they may also be exposed to people who have access to your computer in your home and workplace. Please take these facts into consideration before emailing these forms to me, and know that I suggest printing these forms and bringing them to my office at our first session.
OPTIONAL FORMS
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EXCHANGE OF INFORMATION: If you would like me to coordinate a mutual exchange of information with another entity (such as your health insurance plan, your doctor, or other therapists), we will sign this form together and review exactly what you would like communicated. Any other aspects of your treatment or life will remain confidential.
RELEASE OF INFORMATION: If you would like me to speak to another person or release your treatment records, we will sign this form together and review exactly what you would like communicated. Any other aspects of your treatment or life will remain confidential. ELECTRONIC RECORDS DISCLOSURE: This describes the security measures I use to protect my electronic records and the devices I use to access these records. This is provided for your information. OUT OF NETWORK BENEFITS INFORMATION: I have provided here some guidance for your inquiry into your insurance plan's coverage for providers outside their network. | ||||||||
Disclaimer: The information and resources contained on this website are for informational purposes only and are not intended to assess, diagnose, or treat any medical and/or mental health disease or condition. The use of this website does not imply nor establish any type of therapist-client relationship. Furthermore, the information obtained from this site should not be considered a substitute for a thorough medical and/or mental health evaluation by an appropriately credentialed and licensed professional. This website includes links to other websites for informational and reference purposes only. This website does not endorse, warrant or guarantee the products, services or information described or offered at these other websites. Examine the content carefully.
Photo used under Creative Commons from ell brown.