“Sometimes your joy is the source of your smile,
but sometimes your smile can be the source of your joy.”
--Thich Nhat Hanh
Forms
ALL CLIENTS please print and complete, and/or sign the following forms IN BLACK INK
- Intake Form (both pages)
- Card Payment Consent Form (even if you have Medicare)
- Office Policies and Information Form (only signature page)
- HIPAA Notice of Privacy Practices (only signature page)
- Telemental Health Informed Consent Form (only signature page)
- Consent to Exchange Medical Information
If the client is a MINOR, in addition to the first 5 forms, please also print and complete and bring in the following questionnaire:
If you are seeking COUPLES THERAPY, in addition to the first 5 forms, please also print and complete this questionnaire:
* Each partner should complete his/her/their questionnaire in private
