If you're a new client, please complete the following forms and bring them to your first therapy session.
Client Intake Form 2018
Limits of Confidentiality/Therapy Cancellation Policy
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:
Authorization to Disclose Information Form
An important note about specific prescriptions
Policy Regarding Prescription of Controlled Substances
It may be that during your treatment you will be prescribed a controlled substance such as Adderall, Ambien, Xanax, Ritalin or other similar medication. Safe use of these medications imposes an extra burden of responsibility on both of us. As part of my responsibility I will not authorize early refills or replace lost prescriptions. It is important on your part to understand that I am required to check before any refill is given to see that no similar prescription has been obtained elsewhere. If I find that to be so our doctor patient relationship will terminate.
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