Please download (by clicking on the title of the document) and then review and fill out these documents before the first session.

Please print out the first four documents and complete them prior to the first meeting.   You can transfer a scanned copy of these completed documents during the first session through the telehealth program doxy.me. 

1. Agreement for Services and Acknowledgement of Receiving Notice of Privacy Practices: a document to read and sign. This describes aspects of services.
2. New Client Information: a document to fill out with some basic information about you and what you want from treatment.
3. Symptom Measures:  two brief questionnaires about depression and anxiety symptoms.
4. Teletherapy-Agreement :  a document to read and sign.
5. Notice of Privacy Practices: describes how medical information about you may be used and disclosed.  Please read, but printing it out is not necessary.

 

Additional Documents, if Needed

Patient Portal

Authorization for the Use or Disclosure of Protected Health Information