If you are a new client, please complete all the following forms, print them out, and bring them to your first therapy session. The Insurance Verification Form is for you to understand your insurance plan. Thank you
- Intake Form
- Client Agreement/Good Faith Estimate
- Insurance Verification Payment Form
- Anxiety Symptoms
- Release for Information Form
- Dissociative Experiences Screen
- Depression Symptoms
- Trauma Assessment
As a client, it is your choice and by choicing to do so you understand and agree that you are releasing the information within that communication. The content in these messages may include protected health informat under The Health Insurance Portability and Accountability Act (“HIPAA”). You understand and agree that by agreeing to these forms of communication, you are opting into receiving your own protected health information by email, SMS or mobile telephone notification, which is not secure. You also understand and agree that by receiving such protected health information by e-mail, SMS or mobile telephone notification, you will be charged by your wireless or internetprovider.You can control what information is sent to you, and where it is sent, and you can unsubscribe or opt - out from receiving messages via email, SMS and/or mobile telephone notification.
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