Use and disclosure of protected health information

Psychotherapy information form

Read only forms; they do not require printing or signature

Forms to be completed prior to first appointment

Acknowledgement form

Client information

These forms are to be printed, read, completed, and signed. Please complete them to the degree in which you are comfortable. We will go over them together. The intake form helps provide background for me to understand your situation and for you to clarify and add more information pertaining to the content. You will also be able to ask questions regarding any of the forms before signing.

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Client consent for use & disclosure of protected health information

Arbitration agreement

Additional form to be completed prior to first appointment - pre bariatric evaluation only