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.

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.

COVID19 AGREEMENT

Required for all clients

This form explains my COVID19 policies and procedures, including safety agreements we mutually agree upon.

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.)