Forms:
Please complete and bring with you to our first appointment the New Client Form, HIPPA, and, if applicable, the Insurance Form. All these forms may be printed from the links below.
I will be happy to answer any questions you have about the forms during our first appointment.
If you plan to use Anthem Blue Cross Blue Shield, please be sure to bring a copy of your Insurance Card and your Driver's License.
New Client Information
FORMS NEW CLIENT INFORMATION revised 3.p[...]
Adobe Acrobat document [500.7 KB]
FORMS NEW CLIENT INFORMATION revised 3.p[...]
Adobe Acrobat document [500.7 KB]
New Client Information Consent Form
FORMS NEW HIPAA INFORMED CONSENT 4.pdf
Adobe Acrobat document [470.2 KB]
FORMS NEW HIPAA INFORMED CONSENT 4.pdf
Adobe Acrobat document [470.2 KB]
New Client Insurance Information
FORMS NEW INSURANCE ASSIGNMENT AUTHORIZA[...]
Adobe Acrobat document [180.7 KB]
FORMS NEW INSURANCE ASSIGNMENT AUTHORIZA[...]
Adobe Acrobat document [180.7 KB]
<< New image with text >>
How much we know and understand ourselves is critically important, but here is something that is even more essential to living a wholehearted life: Loving ourselves.
~ Brene Brown
Print 