Forms for Your Appointment

Please print, complete, and bring the following forms with you to your initial appointment. 

If you do not have a printer or otherwise have problems printing, please call me to arrange arriving 30 minutes prior to your appointment time in order to review and complete these forms.

I am unable to meet with you unless these documents are completed before your appointment time (click on each to link to the document):

  1. Welcome Letter & Checklist 2016
  2. Patient Registration 2016
  3. Treatment Information and Consent Form 2016
  4. Fee Policy, Schedule and Agreement–Individual–2016
  5. Notice of Privacy Practices 2016
  6. Receipt of Privacy Practices Notice 2016
  7. Authorization for Release of Info 2016 (if applicable)

 In addition, the following will also be help me complete a thorough assessment.

Please complete and bring to your appointment (click on each to link to the document):

  1. The Adult Information Form (coming soon)
  2. Audit-C to assess alcohol use
  3. GAD-7 to screen for Anxiety
  4. Insomnia Severity Index
  5. PHQ-9 to screen for Depression
  6. PCL-5_criterionA to screen for Post Traumatic Stress Disorder

 I will also need you to bring your Insurance Card and a Government Picture ID.