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):
- Welcome Letter & Checklist 2016
- Patient Registration 2016
- Treatment Information and Consent Form 2016
- Fee Policy, Schedule and Agreement–Individual–2016
- Notice of Privacy Practices 2016
- Receipt of Privacy Practices Notice 2016
- 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):
The Adult Information Form (coming soon)
- Audit-C to assess alcohol use
- GAD-7 to screen for Anxiety
- Insomnia Severity Index
- PHQ-9 to screen for Depression
- PCL-5_criterionA to screen for Post Traumatic Stress Disorder