Forms

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

To access the forms click on each form name. Forms can be filled out using Adobe Acrobat or can be printed and hand filled. Please note that all forms will require written signatures.

• Client Registration Form
• Patient Intake Form

Additional Forms for Reference: 

• Collaterals Agreement
  
• Conditional Confidentiality Agreement
• Electronic Communications Policy
• Informed Consent
• No-Show/Cancellation Policy
• Notice of Privacy Policies and Practices

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

• Release of Records Form – Jessica Harper
• Release of Records Form – Maureen Mench
• Release of Records Form – Melissa Vargo

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