New clients: Please complete all forms below. Forms will be submitted through a secure, encrypted connection. Your privacy is our first priority.
Patient intake form
Informed consent for telehealth services
Consent for treatment and office policies
Consent for the release of confidential information
HIPAA regulations protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
- Suspected child abuse or dependent adult or elder abuse, for which I am required by law to report to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to any other person/s, I must notify the police and inform the intended victim.
- If a client intends to harm him/herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.