Helpful Forms

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

• Registration Form
• Social History   (Adults 18+)
• Developmental Social History    (Children & Teens 0-17 years-old)
• Amen Brain System Checklist     (Adults (18+)
• Child & Teen Amen Brain System Checklist     (Children & Teens 0-17 years old)
• Medical Review of System
• HIPAA Notice
• Acknowledgement
• Consent/Disclosure of Policies
• Notice of Privacy & Practices
• Insurance/Payment Form

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:

• Authorization for Release of Information

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