INTAKE PAPERWORK

 

DISCLOSURE STATEMENT

Required for all clients

This document explains the regulation of therapists, my credentials, confidentiality, and client rights.

HIPAA FORM

Required for all clients

This document describes HIPAA regulations that apply to my practice as a covered entity.

ADULT CLIENT INFORMATION FORM

Required for adult clients

This form provides me with important information about you as a client. (Family clients: ask me whether you should complete this in addition to the child information form.)

CHILD INFORMATION FORM

Required for child clients

This form provides me with important backround information about your child and family.

DIVORCE CUSTODY AGREEMENT

Required for child clients

This form clarifies my roles as a provider and describes other practitioners who can support families going through divorce and/or custody proceedings.

RELEASE OF INFORMATION

Optional 

Complete this form if you would like me to communicate with other professionals/individuals (e.g., school, doctor, etc.)

GROUP DISCLOSURE & AGREEMENT

For group participants

These forms explain the laws and regulations of group therapy/workshops, as well as policies for the COSP group.

MINDFULNESS MEDITATIONS

Below are audio files of mindfulness meditations, recorded by me. These are free to download and are meant to supplement therapy. These meditations do not replace mental health services, and I encourage clients to communicate with me prior to practicing each of them so that we can integrate it into our treatment plan.

SAFE SPACE

This meditation guides you through a full sensory experience in your selected "safe space." This can be helpful for relieving stress. ~7 minutes.

BODY SCAN

This meditation guides you through a mindful scan of the body. This can be helpful for relaxing or increasing awareness of the body. ~7 minutes

PROGRESSIVE MUSCLE RELAXATION

This meditation invites you to actively relax various muscles of the body. It supports bodily awareness and reduction of stress. ~14 minutes