Intake Forms

01. New Client Questionnaire

  • Bellow you will find a list of common challenges people face. Please check any that apply to you at present.
  • Type your full name
  • Date Format: MM slash DD slash YYYY

03. Treatment Contract

  • Type your full name
  • Date Format: MM slash DD slash YYYY

04. HIPAA Notice

  • Type your full name
  • Date Format: MM slash DD slash YYYY

05. Video Therapy Informed Consent

  • Type your full name
  • Date Format: MM slash DD slash YYYY

06. Release of Information (as requested)

  • Date Format: MM slash DD slash YYYY
  • Type your full name
  • Date Format: MM slash DD slash YYYY