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Blue Mountains
Blue Mountains

Helpful Forms

If you're a new client, please complete the following fill-able forms and send them back using the "Secure File Transfer" link.

 

If you're a new client, please complete the following forms and bring them to your first therapy session.

Client Psychotherapy Intake Packet 

Consent for Treatment and Limits of Liability

Notice of Privacy Practices

Authorization to Use and Disclose Protected Health Information

Disclosure Statement

Secure File Transfer

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Authorization to Disclose Information Form 


Note: To download Adobe Acrobat Reader for free, click here.

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Helpful Forms

Click here to view and print forms for your appointment.

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