Office Policies and Intake Forms


Prior to our first session, read my policies then download and complete these forms and bring them in with you:


1. Intake Forms

Disclosure of Office Policies; General Information, Family of Origin Information, Medical/Psychological History


2. HIPAA Notice of Privacy Practices 

Please read and sign the form.


3. Health Insurance Claim Form (HICFA 1500 - 12/90)

Please complete the "Patient and Insured" section on Page 1 only.



These forms are provided in Adobe Reader (PDF) format. To view and print them, you will need the Free Adobe Reader, available here.