If you are scheduled for an intake appointment:

Adult clients: Please download the Informed Consent – Adult form and the Adult Intake Questionnaire and bring both completed forms to your appointment.

Adult Couples: Please download the Informed Consent – Adult form and the Adult Intake Questionnaire for each person, and one copy of the Couple’s Confidentiality Agreement, and bring the completed forms to your appointment.

Child clients: Please download the Informed Consent – Child form and the Child Intake Questionnaire and bring both completed forms to your child’s appointment. Please note that BOTH parent’s or guardian’s signatures are required.

To provide written authorization to release records or communicate with anyone other than a parent/guardian (for children) or PCP, please download the Authorization for Release of Protected Health Information.

If you have any questions about our office policies, please let us know at your appointment.

Informed Consent – Adult
Adult Intake Questionnaire
Couple’s Confidentiality Agreement

Informed Consent – Child
Child Intake Questionnaire
Authorization for Release of Protected Health Information

 

During the COVID-19 Health Crisis, we have some extra consent forms you may also need to complete: