Before We Meet:
POLICIES FORM: My Policies Form combines three separate forms which explain my office procedures and agreement for psychotherapy services. This includes important information about your confidentiality. My Social Media Policy explains my policies and procedures as they relate to our potential interactions on the Internet. I am also 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. These are all included on this one document. Please let me know if you have questions or concerns about any of these policies.
Print, Complete & Bring to Your First Session:
INTAKE FORMS: Prior to our first session, please complete my Intake Forms, which include important information about you, as well as forms for you to indicate your record keeping preferences (paper or electronic or a hybrid), and the acknowledgment form that indicates you have access to the policy forms above. Please do not email these back to me, but, rather, print them and bring them to our first session.
During our Work Together:
ATTACHMENT HISTORY: At some point in our work, I have all relationship partners and many 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.