Before We Meet:
POLICIES FORM: My Policies Form explains my office procedures and agreement for psychotherapy services. This includes important information about your confidentiality. If you have questions after reading this form, please bring them up when we meet.
SOCIAL MEDIA POLICY: My Social Media Policy explains my policies and procedures as they relate to our potential interactions on the Internet. Please let me know if you have questions or concerns about these policies.
HIPAA: I am required by law to provide you with a copy of the HIPAA Notice of Privacy Practices so you can understand your rights and protections related to the use and disclosure of your identifiable health care information.
Print, Complete & Bring to Your First Session:
CLIENT INFORMATION FORM: Prior to our first session, please complete my Client Information Form and bring it to our first appointment. This will help you share important details with me while allowing our first meeting to unfold more naturally.
RECORD PREFERENCES FORM: I keep both paper and electronic records and I am committed to honoring your preferences regarding storage of your records. My Record Preferences Form gives you more information and lets you indicate your preference.
ACKNOWLEDGMENT OF NOTIFICATIONS: Once you have read my Policies Form, my Social Media Policy, and the HIPAA Notice of Privacy Practice form, please sign my Acknowledgment Form. This states that you have access to and have read all forms. Bring this to our first session.
During our Work Together:
ATTACHMENT HISTORY: I have all couples and individuals complete an attachment style questionnaire so that we can use this in our work together. Please print out your results and bring them in. If you have multiple partners or feel that your responses vary depending upon different relationships, please focus on the relationship we are working on in therapy in your response. Or you may complete separate surveys for different partners.
THOUGHT RECORD: Sometimes I use Thought Records in my work with clients. If you need extras, you can download this one.
If you are seeing me for Insomnia, I will have you complete a 7-day sleep diary to track your sleep habits.
TELETHERAPY CONSENT FORM: If we decide teletherapy services make sense for you, I will have you sign my consent form for these services.
REDUCED FEE AGREEMENT: If your circumstances change and you need to request a fee adjustment, I will have you complete my Reduced Fee Agreement form.
COLLATERAL CONSENT FORM: If we decide that it is important for me to meet with another person in your life who wishes to support your treatment, you and I will make a detailed plan for how this might best work. We will also have this individual read and sign this form.
AUTHORIZATION TO RELEASE INFORMATION: There may be times when you and I agree it would be helpful for me to speak with another person to coordinate your care. With the exception of the situations outlined in the HIPAA form, I cannot do this without your written consent. Usually, we will speak about this in person and you will sign the form in my office. However, if you’re unable to meet with me, you may complete my Authorization to Release Information Form and send it back to me.