Forms

I am providing telehealth video sessions during this unique time period of the pandemic

I generally only provide in-person therapy in my office, however under certain conditions, telehealth such as video or phone sessions, may be an important temporary option.

• Telehealth Agreement:  Telehealth Agreement

If you would like to complete the forms before you arrive for the first appointment, you may download and complete the appropriate forms and bring them with you.  If you complete them ahead of time, you do not need to arrive early.

• Client Contact Form: Client Information
• Wellness Questionnaire: Wellness Questionnaire
• Notice of Privacy Practices Acknowledgment: NPP Acknowledge

Insurance Forms if applicable:

• Consent Form: Insurance Consent (complete if you are using insurance or other payor)
• Insurance Claim Form: Ins Claim1500 (complete if you are using insurance or other payor)

Policies

• Notice of Privacy Practices Policy: NPP-Notice Privacy Practices
• Notice to Clients:  Notice to Clients