If possible, please bring these completed forms to our first session. If you have questions about any of them, please don’t hesitate to ask.
1) Fill out the brief Confidential Client Information form, which helps me collect some basic information that otherwise we’d take time to do when we meet, and will also help identify what you’d like to work on together.
2) Sign the Acknowledgment of Receipt form, which I will keep in your file. It acknowledges that I’ve offered you a copy of two additional forms:
3) Protecting the Privacy of Your Health Care Information, which is the federal form about privacy, and
4) the Psychotherapist-Patient Services Agreement, which goes over a number of logistical details about how we’ll work together. This Agreement includes information about my cancelation policy, confidentiality, insurance reimbursement, and so forth. Some people like to go over these details in person, and others prefer to get them out of the way in advance; either way, please bring the Agreement—and note anything about which you’re curious or uncertain, so we can discuss it.
5) Click here for information about payment and billing options.
6) If there is another health care professional with whom it would be helpful for me to discuss your concerns, please complete and sign the Consent for Release of Information.
7) Finally, if you are eligible for Medicare, please note that I am not a Medicare provider. Please complete and sign the Medicare Private Contract form.
