Please fill out the form that applies to you or your child's age and bring them to your first appointment, and any court documents (if applicable).  If you have a custody agreement, we must have a copy of this on file prior to seeing your child. 

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• Child Intake Form OR Teen Intake Form

• Consent for Treatment &

• Informed Consent of Policies (3 TOTAL FORMS)

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• Adult Intake Form &

• Informed Consent for Adults  (2 TOTAL)

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If you are participating in group therapy, please view and sign this consent form for services:

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• Group Therapy Consent for services

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If you would like your therapist to coordinate care with another provider at any point during therapy (i.e,, psychiatrist, physician, other family member, step-parent, etc.), complete this form to authorize release of psychotherapy information:

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• Consent to Communicate (minor)

 

Confidentiality & Privacy Policy

The law protects the relationship between a client and a therapist, and information cannot be disclosed without written permission.

Exceptions include:

• Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.

• If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.

• If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.