After you have scheduled your very first visit with me, I will send you a secure link via email to complete documents online via Simple Practice. Completing these ahead of time (preferably at least a day or two prior to your intake session) will allow us to begin on time and maximize the potential for your session.
These documents listed below are for backup purposes only should the Simple Practice site not be working correctly. Please make every effort to complete online when you receive the link.
In the event these forms must be used, please print, complete, and scan these forms back to me prior to your intake or upload to Simple Practice). ** Update, forms below have been unlinked, Please complete forms in Simple Practice. **
- Consent for Treatment (Agreement for Services):
- Consent for Treatment (PDF)
- Notice of HIPAA Privacy Practices (How your personal information is used):
- Notice of Privacy Practices (PDF)
- Adult Client Information Form (18 years of age and up):
- Adult Client Information Form (PDF)
- Youth Client Information Form (0-17 years of age, guardian to complete):
- Youth Client Information Form (PDF)
- Insurance Agreement Form (For clients using their insurance benefits):
- Insurance Agreement Form (PDF)
- Insurance Opt-Out Form (For clients who decide to opt-out of using their insurance benefits for which I am In-Network):
- Insurance Opt-out Form (PDF)
- Distance Counseling Form (For clients who have been screened for online distance counseling only)
- Distance Counseling Consent and Agreement (PDF)
To view, download, and print these documents, you must have Adobe Reader installed on your computer. Please click the link below to obtain a copy of Adobe Reader.
