For your your convienience, please download and bring with you to first appointment
Forms for all service
HIPPA notice: this form explain how the law regulates your privacy i.e. when and with whom I can or must share your health information. By signing the form you acknowledge that I provided you this information.
Intake Form: the purpose is to provide your basic demographic/contact information and your psycho-educational-social history. When you do this I will be able to devote our initial evaluation for the most part to your presenting concern, versus spending time collecting history.
Medical Intake Form: as medical conditions and medications can impact psychological function, it is important to provide this medical information. Make sure to list the dose and time at which you take medication
Forms for all therapy services
Office Policies and Consent to Treatment: this form explains my policies. By signing you agree to the policies and to receive the treatment you requested (i.e. therapy)
Reason for Therapy: this form is designed to help you think through what you want to work on and what you want to achieve. Take your time with this form: it’s a tool I put much thought in to help you jumpstart your therapy and use your face to face time in the most effective possible way
Forms for Neuropsychological Evaluation
Office Policies and Consent to Treatment: this form explains my policies. By signing you agree to the policies and to receive the treatment you requested (i.e. neuropsychological evaluation).
Additional Consent Form for RRT
Consent to Treatment with RRT: this form is in addition to the Office Policies Form and explains specific issues related to hypnosis.