Forms

If you're a new client, please complete the following forms and bring them to your Assessment session.

•  Consent-form-for-behavioral-SUD-telehealth-services
• Admission Form
• Release of Information
• Individual Rights Signature Form
• Notice of Privacy Practices and Confidentiality
• Sliding Fee Application

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

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