Forms

Intake Form

Please bring this form with you to our first meeting. During telehealth, you can email it to me. If this is the first meeting with your tween or adolescent, the form will best be filled out together, if possible.

Intake Form

Confidentiality and Cancellation Policy

Please read these forms closely, sign, and bring them to our first meeting.

Form

Payment responsibility and agreement form

This form explains payment options and authorizes me to submit claims on your behalf to the insurance company

Form

Authorization for release of information

This form will only be required as needed. It allows you to give me permission to speak and/or exchange information with another professional. For example, if it would be important for me to speak to a doctor, psychiatrist, or school personnel.

Form