Forms & Information
There are several forms that you need to fill out prior to your first visit. Some forms require your signature so these must be printed and signed. The general information forms (Intake Forms for example) do not require a signature so they are available to fill out online.
Required Forms for First Visit:
| # | Form Name | Download | |
| 1) | Adult Intake Form (contact info, insurance, medical history, etc) |
 Download |
|
| 2) | Privacy Policy (information about privacy) |
Download |
|
| 3) | Privacy Policy Acknowledgment (signature required) |
Download |
|
| 4) | Payment Release & Cancellation Policy (office policy, signature required) |
Download |
|
| 5) | Credit Card Payment Authorization | Download |
|
| Additional Forms for Parents of Minor Children | |||
| 5) | Child Intake Form (additional information for minor children) |
Download |
|
| 6) | Consent to Treat a Minor (signature required) |
Download |
|
If you would like to scan and upload forms, please go to to Upload Forms Page when you are ready to send your forms.
License
Licensed to practice Clinical Social Work
Member of the National Association of Social Workers
