Forms
When people are new to my practice, or when it has been longer than six months since our last meeting, I have folks complete the forms below. You may email them to me or bring them with you to our next scheduled appointment.
Consent for Treatment - This form provides you information on my practice, informed consent to engage in treatment, and informed consent to use electronic means (e.g., email, text, and videoconferencing) when contacting me.
COVID-19 Release - Whenever possible, I meet with patients in person. At this time, both of us will be wearing masks during sessions. This form provides you informed consent to receive treatment in person during the COVID-19 pandemic. While I cannot guarantee that my office is free from COVID-19, I air it out between sessions, and have a Molekule air purifier running continuously.
Release of Information - Please complete this form if you are working with another mental health professional (e.g., psychiatrist; current therapist) so that I may be in contact with them to coordinate your care and our work together. I may also ask that you complete this form if I need to be in contact with a previous therapist, your primary care physician, another medical provider, or another person or agency involved in your care.