In order for us to get off to a great start in therapy, I am requesting that you complete the following forms. Some forms are for legal compliance; other forms request information that is clinical. Much of this information is considered Protected Health Information (PHI). I am collecting this data via Google Forms. I have signed a Business Associates Agreement with Google which means that my account complies with all HIPAA requirements. If you have questions about Google’s HIPAA compliance, you can read about it here.

Please complete the follow documents in order. You do not have to complete all documents in one sitting, but you will need to complete each document in one sitting as they cannot be saved and completed at a later time.

Client Information Brochure

Notice of Privacy Practices

Informed Consent

Informed Consent to Video

Client Therapist Agreement

Individual Intake

Couples Intake: Only complete this form if you are seeking couples or relationship counseling

Emergency Contact Release

Client Bill of Rights

Agreement to Pay

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