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Client Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

Client Data Form - For adult clients (18 and up)

Parent Questionnaire - For child and adolescent clients (up to 18)

Authorization to Disclose Protected Health Information (PHI)

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information.

Outcome Rating Scale (ages 18 and up)

Child Outcome Rating Scale (ages 10-18)

Young Child Outcome Rating Scale (ages 10 and under)

Note: To download Adobe Acrobat Reader for free, click here.

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Helpful Forms

Click here to view and print forms for your appointment.