Forms

You are welcome to email me the forms, bear in mind that e-mail is not HIPPA compliant and you may also mail the forms to my office at the Stoneham address. If services are in person, bring the forms to your first office visit. I will need signed copies of the Financial Services Agreement, the Adult Client Information Questionnaire, and the TMH.Consent below for your first intake session.

Read but do not do anything with (you will confirm you read this on the Adult Client Questionnaire) 

AdultClientConsent

Fill out the and sign the three following forms (extra copies included for your technology needs). I will need these before you first intake appointment 

Financial Services Agreement

Adult Client Information Questionnaire (PDF)

Adult Client Information Questionnaire (Word Document)

TMH.Consent (Word Document)

TMH.Consent (PDF)

Because we all love reading forms, these are available for your perusal: 

HIPAA 

 

If you are a parent of an adolescent you will may find these forms more friendly for your needs:

Adolescent.ParentConsent

Adolescent.ParentQuestionairre (PDF)

Adolescent.ParentQuestionairre (Word Document)