Notices & Forms

Please review the following four notices for your information (do not need to print or bring to appointment):

HIPAA Notice of Privacy Practices (pdf)

No Surprises Act Notice (pdf)

Telemental Health Notice (pdf)

Right to Good Faith Estimate Notice (pdf)

Please print at home, complete before appointment, and bring to our first psychotherapy meeting the following consent form:

Client Background Info Form (Optional) (pdf)

Information, Authorization and Consent to Treatment 2024 (pdf)

Powered by