If you're a first-time client, please review and complete the following forms, fax them to me before the first session (especially insurance verification form) or bring them to your first session.
- Client Personal History / Intake Form
- Couple's Counseling Information Form -One for each person ***Note: If you are coming for couples counseling please also fill out the adult intake form for both people***
- Personal History - Children and Adolescents (<18)
- Limits of Confidentiality/Cancellation and Payment Policy Form
- Your Family Matters Insurance Verification form
If you would like me to coordinate care with another provider (for example, your medical doctor, psychiatrist, endocrinologist, etc.), complete this form:
- Consent to Release Information Form
Note: Applicable forms below must be downloaded, printed and filled out manually. Then scan and email to email@example.com. You may also fax them to (763-427-5688). If necessary they also may be brought to the first session.
Note: To download Adobe Acrobat Reader for free, click here.