The following forms are important in helping us establish a clear and effective therapeutic relationship. To print them you will need Adobe Acrobat Reader. If you do not have this program on your computer, you can download it for free by clicking here. Please print, read, sign, and bring with you the appropriate forms to your first therapy appointment.
Client Intake and Office Policies Form. This completed intake form should accompany you to your first appointment with me.
Client Intake and Office Policies Form Workers’ Compensation Form. This form should be completed by injured workers whose treatment will be paid for by their employer’s workers’ compensation insurance company.
Notice of Privacy Practices Form. I am required by law to provide you with a copy of the HIPAA Notice of Privacy Practices that I adhere to in my practice. Please print and bring it with you to your first appointment. I will respond to any questions you have and ask you to sign this form at our appointment.
Authorization to Release Information Form. This form provides me with authorization to communicate with other health care providers involved in your treatment to coordinate care. It is an optional form for most clients.
