Patient Forms

Patient Forms can be downloaded and/or printed off from the clickable PDFs or
Word Dociments at the Bottom of the Page

If you're a first-time client, please review and complete the following forms, bring them to your first session.

• Personal History Form

If another person is financially responsible for your counseling fees, please have them fill out this form and bring it with you.

• Insured's payment agreement. 

If you would like me to coordinate care or release information to another provider (for example, your psychiatrist, endocrinologist, etc.), lawyer, or any other person designated by you, please complete this form:

• Consent to Release Information Form

If you would like for me to find out about your insurance benefits before your appointment, please print  the insurance release, sign it, and fax it back to me with a copy of your insurance card (both sides) and a copy of the face sheet with your demographic information.

• Insurance Release Form
• Face Sheet Form

If you are not seeking counseling with me at this time, but would like to consult with me about some specific issue, you may set up an appointment for consultation either over the telephone or by internet.  Any consultation session is for educational/informational purposes only and does not constitute a therapeutic relationship.  Consultation is not intended to substitute for advice or treatment of a marital or addiction therapist or other mental health professional.  It is not intended to be used to diagnose, treat, cure, or prevent any diesease or illness (inclluding mental illness). 

• Telephone Consultation Form and Disclaimer
  

Free Information Downloads

There are several free downloadable workbooks or booklets listed below.  They are in public domain and are written and/or published by governmental agencies or departments.  All of the booklets and workbooks in PDF format are excellent sources of information.  Click below on the PDF icons to access these recources.

• Anger Management Workbook (Published by SAMHSA)
• Depression Booklet
• Anxiety Disorder Booklet
• Panic Disorder Booklet

 

 

Consent to Release Information Form
Personal History Form
Insured's Financial AgreementR
Anger Management Workbook
insurance release
Face Sheet Form
depression booklet
anxiet disorder booklet
panic disorder booklet
Consent for Services Form
Phone Consultation Form

Note: To download Adobe Acrobat Reader for free, click here.

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