IMPORTANT!
Before your first appointment, please call your insurance company and find out the following information:
Do I have mental health benefits?
How many sessions per calendar year does my plan cover?
Do I need an authorization number?
What is my deductible and has it been met?
Do I have a copay? How much?
How much do I pay for an out-of-network provider?
Client Forms:
If you have made your first appointment, please find
the appropriate forms below as was indicated to you by your therapist. You may
either fill them out on your computer (Word document versions only) and then email
them to your therapist before your first appointment, or print out the forms,
fill them out by hand and bring them with you on your first appointment. Please
note that the Psychotherapist-Patient Services Agreement form MUST
be printed out, signed, and brought with you.
You also have the option
of arriving for your first appointment 30 minutes early to complete ALL this paper work
in the office (including the services agreement).
- Psychotherapist-Patient
Services Agreement -- PDF (must be printed
and signed)
- Client Information Form -- PDF
- Adult
Intake
Assessment for Therapy Clients -- PDF
- Social Media Policy -- PDF
- Limits of Confidentiality for Couples/Family -- PDF
- Adult
General Symptom Checklist -- PDF or Word
Document
- Child/Adolescent Forms
- Child Therapy Contract -- PDF (must be printed
and signed)
- Family Therapy Waiver -- PDF (must be printed
and signed)
- Family Therapy Waiver for Spouse/Ex Spouse -- PDF (must be printed
and signed)
- Intake Form for Child/Adolescent Psychotherapy -- PDF
- Consent for Treatment of Minor/Child Assent Form-- PDF
- Adolescent Informed Consent -- PDF
- Child/Adolescent Symptom Monitoring Form -- PDF
- Childhood Depression Inventory -- PDF
- Child/Teen General Symptom Checklist -- PDF
- Child/Teen Brain System Checklist -- PDF
- Learning Disability Child/Teen Screening Questionnaire -- PDF
- Outpatient
Services Agreement for Collaterals -- PDF
- Informed Consent for Intended Parents -- PDF
- Fertility Health History for Intended Parents -- PDF
Couples Homework - to be completed for your first session: It is important that we do not ONLY focus on the hurtful/negative aspects of your relationship.
- Describe the relationship you would like to create.
- What do YOU need to do/change to become a more effective partner?
- How or why would this be difficult for you?
- How motivated are you to make that change?
- What is your level of motivation to work on your personal difficulties?
- If you know that you are breaking up, what do you need to do to split most effectively so that the least amount of wounding will take place?
Read: How to Get the
Most Benefit From Couples Therapy before your first session. Underline
what stands out to you and bring it to your first session.
Please
feel free to contact us with any questions or concerns.
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