Intake Paperwork

Please complete and return the forms below. Once we receive the paperwork along with a copy of your insurance card (if applicable), we will reach out to you to schedule your intake appointment.

Intake Forms

Client Registration Form

This form asks for demographic and insurance information

*Please make sure to include a copy of the front/ back side of your insurance card when returning this form

Client Registration Sheet

Protected Health Information

The PHI form is used to obtain consent or authorization for the use and disclosure of a person's health information. The Health Insurance Portability and Accountability Act (HIPAA) ensures that sensitive patient data is kept private and secure.

Protected Health Information

Telehealth Authorization

This document grants permission for healthcare providers to deliver behavioral health services remotely through telecommunication technology, such as video calls or phone consultations. We use the HIPAA compliant Zoom platform

Telehealth Authorization Form

Release of Information

Optional: This document authorizes the sharing or disclosure of a person's personal, medical, or confidential information from one party to another. Complete if there are other providers in your care team you would like your therapist to connect with

Release of Information

Intake Paperwork

Intake Forms

Client Registration Form

Protected Health Information

Telehealth Authorization

Release of Information

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