The following forms and documents are provided for your
convenience (PDF format).
As a health care professional, I am required by federal law (HIPAA) to provide you with a statement of my office's privacy practices. (I can provide a paper copy when we meet if you wish.) In our first meeting, I will need to ask you to sign a statement saying you have received this Notice
Notice of Privacy Practices
The Client Information Form will give me some basic information about you that will be helpful to me in our work together. Please fill out and bring a copy to our meeting if that is possible.
Client Information Form
The Psychological Services Contract is asking you to enter into an agreement about how we will work together. If you have any questions or concerns, we can discuss it when we meet. If you can print it out, please initial each page and sign the last page.
Psychological Services Contract
Caffeine Consumption Questionnaire
For your information:
On Choosing a Psychologist and Payment Options
Print as needed or I can provide this in session:
Authorization Consenting to Release of Information
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