Forms 2017-06-01T07:49:15+00:00

Forms to Download

For your convenience I have placed the following forms on this website in Adobe PDF format so that you can download, fill them out on your computer or by hand and then print them out prior to our first appointment, if you choose. Information you provide on these forms is held to the same standard of confidentiality as our therapy.

Patient Information Form

This is a very brief form to gather your contact and insurance information. You may fill it out and bring it to your first appointment or allow yourself 5 minutes prior to your appointment to complete the form in the office.

Adult Biographical Information Form

This form covers basic information about your medical history, family background, current concerns and symptoms. It will assist me in determining the best therapeutic course of treatment for you. You may either fill it out and bring it to your first appointment, or allow yourself 20 minutes prior to your appointment to complete the form in the office.

Child and Adolescent Biographical Information Form

This form is similar to the Adult Biography but covers the information that will assist me in determining the best therapeutic course of treatment for your child or adolescent. You may either fill it out and bring it to your first appointment, or allow yourself 20 minutes prior to your appointment to complete the form in the office.

Therapeutic Agreement

This form lays out my administrative policies and procedures. You may fill it out, sign it and bring it to your first appointment, or you may wish to read it and then discuss it with me before signing it.

Please don’t hesitate to contact me with any questions.