Reach out to us: 602.508.9190

Forms

Below you'll find the the intake forms for my practice.  Please read through your introductory email to determine which forms are necessary for you to fill out and bring in with you to your first appointment.  I look forward to meeting you!

Forms will be sent via our website once an appointment is scheduled.

---

Client Intake

intake_form_2015.pdf
File Size:	120 kb
File Type:	pdf

Download File

---

Client Re-Intake

reintake_form_2015.pdf
File Size:	73 kb
File Type:	pdf

Download File

---

Limits of Confidentiality

limits_of_confidentiality_2015.pdf
File Size:	27 kb
File Type:	pdf

Download File

---

Treatment Plan & Informed Consent

treatment_plan_2020.pdf
File Size:	65 kb
File Type:	pdf

Download File

---

Policies & Procedures

policies_7_2017_final.pdf
File Size:	165 kb
File Type:	pdf

Download File

---

HIPAA Privacy Practices

hipaa_statutes.pdf
File Size:	110 kb
File Type:	pdf

Download File

---

Release of Information

insurance_consent_to_release_info.pdf
File Size:	49 kb
File Type:	pdf

Download File

---

Amen Checklist

amenchecklist.pdf
File Size:	35 kb
File Type:	pdf

Download File

---

Communications Policy

communications_policy_2015.pdf
File Size:	52 kb
File Type:	pdf

Download File

---

Teletherapy Informed Consent

telepsychology_informed_consent_2020.pdf
File Size:	152 kb
File Type:	pdf

Download File

---

Credit Card Authorization Form

credit-card_-_authorization-form2020.docx
File Size:	101 kb
File Type:	docx

Download File

---