Forms

Forms

Adults: Read the HIPPA Document and the Adult Client Consent.  Print and fill out the Adult Client Questionnaire and the Finance Agreement, and bring both to your first office visit. (Note that you do not have to print and bring the first two documents, but confirm that you have read them with a “check” on the Adult Client Questionnaire). For your convenience, a copy of the Adult Client Information Questionnaire is available to you in both a Word Document and PDF format- you may use either one.

Parents of adolescents/adolescents: Read the HIPPA Document and the Adolescent.Parent Consent. Print and fill out the Adolescent.Parent Questionnaire and the Finance Services Agreement, and bring both to the first office visit. (Note that you do not have to print and bring the first two documents, but please confirm that you have read them by putting a confirmation “check” on the Adolescent.Parent Questionnaire). For your convenience, a copy of the Adolescent.ParentQuestionnaire is available to you in both a Word Document and PDF format- you may use either one.

HIPPA Document

AdultClientConsent

Financial Services Agreement

Adult Client Information Questionnaire (PDF)

Adult Client Information Questionnaire (Word Document)

Adolescent.ParentConsent

Adolescent.ParentQuestionairre (PDF)

Adolescent.ParentQuestionairre (Word Document)