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Client Forms

New Client Registration Forms

For your convenience, you may complete the necessary registration forms at any time before your first appointment. This will save you time when you arrive in the office, and will not cut into your allotted session time.

The forms are in .pdf, which you can read and fill out using Adobe Reader. (If you do not already have Adobe Reader on your computer, go to www.adobe.com for a free download or a free update, as needed.)

Please print out the forms you have filled in, and bring them with you to your first appointment.

If you are unable or do not wish to complete these forms on the computer, you will be provided with blank forms that you can fill out by hand at the office, prior to your appointment.

New clients are required to complete the following forms:

    New Client Registration
    Insurance Benefits Worksheet (if you are not using insurance,
       you do not need to complete this worksheet form)

    Information, Authorization and Consent to Treatment
    Consent to Use and Disclose Health Information*
    Authorization for Credit/Debit Card Billing

IN ADDITION -
All new adult clients (age 18 and older) are required to complete the following form:
    Adult Client Information Questionnaire

All new minor clients (under age 18) are required to have the following form completed by a parent/legal guardian:
    Minor (Child) Client Information Questionnaire


 * you can read the Notice of Privacy Practices at the office, or here


Assessment Forms

From time to time, you may be asked to complete various questionnaires or ratings scales to assist in assessment of your treatment needs. Having this information can help me be more effective in helping you meet your therapy goals.

Some of the forms in this section are password-protected; you will be provided with the appropriate password for any of these that you are asked to complete.

Some of the forms are in .pdf, which you can read and fill out using Adobe Reader. (If you do not already have Adobe Reader on your computer, go to www.adobe.com for a free download or a free update, as needed.)

Couples/Marital Assessment
          · Couples Assessment Packet 

Attentional Inventories
          · Attention Control
          · Hyperactivity