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Helpful Forms

PLEASE ARRIVE 15 MINUTES EARLIER THAN YOUR SCHEDULED APPOINTMENT TIME TO COMPLETE THE CHECK IN PROCESS

If you are a new adult client, please complete the following forms and bring them to your first session.

  • Initial Client Intake Form pages 1,2 (As of Jan. 2012 The No-Show fee is 75.00 and the late cancellation fee 55.00)
  • Client Intake Form pages 1, 2  
  • Please Read Privacy Practices Form pages 1,2,3
  • Sign Acknowledgement of Reading Privacy Form
  • Financial Policy Form pages 1,2 

If you are bringing in a minor to be seen, please complete the following forms and bring them to your first session. 
  • Initial Client Intake Form page 1,2
  • Client Intake Form pages 1,2
  • Client Intake Form for a Minor pages 1,2,3
  • Consent to Treat a Minor pages 1,2
  • Please Read Privacy Practices Form pages 1,2,3
  • Sign Acknowledgement of Reading Privacy Practices
  • Financial Policy Form pages 1,2

 


Client Intake Form  
Privacy Practices Form Page 1  
Privacy Practices Form Page 2  
Privacy Practices Form Page 3  
Client Intake Form for a Minor. Page 1 of 3  
Client Intake Form for a Minor. Page 2 of 3  
Client Intake Form for a Minor. Page 3 of 3  
Financial Policy Form Page 1  
Financial Policy Form Page 2  
Consent to Treat a Minor. Page 1 of 2  
Consent to Treat a Minor. Page 2 of 2  
For Cash Payers: Prompt Payment Information Form  
Acknowledgement of Reading Privacy Practices Form  
Initial Client Intake Form page 1  
Initial Client Intake Form page 2  

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

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Helpful Forms

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