Patient Forms

Several forms need to be completed before your first appointment. All forms are available at the office, however filling them out in advance saves time. Please print and complete the following documents. Forms required are noted by an asterisk. Please feel free to contact me if you have questions regarding any of the forms.


*Informed Consent


*Client Information


Notice of Privacy Practices: This is your copy of Notice of Privacy Practices


*Notice of Privacy Practices Acknowledgment


*Insurance Checklist: If you plan on using your insurance benefit, please use this form as a guide to contact your insurance company to confirm mental health benefits.


*Assignment of Benefits: Required if using insurance benefits


Credit card Agreement: If you wish to use a credit card for payment of services, please complete this form

All Forms
This PDF contains all of the forms listed below in a single document.
Adobe Acrobat document [101.1 KB]
Informed Consent
Adobe Acrobat document [63.0 KB]
Client Information
Adobe Acrobat document [55.6 KB]
Notice of Privacy Practices
Adobe Acrobat document [38.8 KB]
Insurance Checklist
Adobe Acrobat document [39.1 KB]
Assignment of Benefits
Adobe Acrobat document [28.3 KB]
Credit Card Agreement
Adobe Acrobat document [29.1 KB]

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