Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

• Client Psychotherapy Intake Form
• Client Demographic and Insurance Information Form
• Patient Health Questionnaire (PHQ-9)

If you are experiencing any specific mental health issues, please print out and complete the corresponding assessment:

• Depression Scale
• Anxiety Assessment
• Anger Management Scale
• Stress Management Inventory
• Adult ADHD Questionnaire
• Child and Adolescent ADHD Questionnaire

The following forms need to be completed, signed and brought in to the first session in order for treatment to begin:

• HIPPA Form
• Consent Policies and Agreement
• Credit Card Authorization Form

For those clients seeking Alcohol and/or Substance Abuse Treatment or have an Addiction Issue, 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:

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.