If you have been accepted as a new patient, print and complete the following forms and bring them to your first visit. Please note, there are separate forms for adults and children. If the primary focus of the service is for a child/youth under 19 years of age, please complete all four child documents. If the primary services will be provided to someone 19 or older, please complete all four adult documents.
Primary Focus: Child Primary Focus: Adult
Complete the Authorization Form to authorize release of psychotherapy information to other persons, such as your psychiatrist, school, etc.:
If parents/guardians are separated or divorced, the Agreement for Child Psychotherapy with Separated or Divorced Parents/Guardians is to be signed by both parents/guardians.
The Notice of Privacy Practices describes how psychological and medical information about you/your child may be used and disclosed:
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