- HIPAA Privacy Notice & Service Agreement
- Notice of Privacy Practices (Read/Keep)
The Notice of Privacy Practices describes your privacy rights and my responsibility as a psychologist to safeguard your Protected Health Information (PHI). The document also clarifies issues related to confidentiality. This notice is for you to review and keep.
- Service Agreement (Read/Keep)
If pursuing individual mental health services, this Service Agreement describes my office policies, counseling expectations, risks and benefits of individual mental health services, and other very important information. This document serves as the agreement between you and me concerning the therapeutic process. The information gives you a good idea of what to expect when choosing to work with me. During the first meeting, we will review and sign.
- Adult Individual Therapy Forms (Ages 18+)
- General Client Information
This form contains information that I need to be able to contact you. The form also includes information about your personal background that helps me to begin the process of getting to know you.
- Client Concerns Form
This form contains questions related to how you are doing. The answers to these questions help me better understand your current challenges, strengths, and also your important history. If you have questions about this form, please ask me and we can further discuss.
In order to assess whether I can assist you, I would like to have a brief conversation with you by phone prior to scheduling an appointment.