If you're a new client, please complete the following forms and bring them to your first therapy session.
- Client Psychotherapy Intake Form
- Client Intake Form #2
- Patient Health Questionnaire (PHQ-9)
- Limits of Confidentiality/Therapy Cancellation Policy
- Credit Card Authorization Form
For those clients seeking alcohol and/or substance abuse treatment, please complete the following assessments:
- CAGE Alcohol Questionnaire
- Alcohol Use Disorders Identification Test (AUDIT)
- "I drink because"...worksheet
- Drug Abuse Screening Test (DAST-10)
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:
Note: To download Adobe Acrobat Reader for free, click here.