Helpful Forms

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

ABTA Client Intake Form

ABTA Adult Information Form

QSP

Problem Checklist -1

Problem Checklist - 2

ABTA Client Consent Form

ABTA HIPPA NOTICE

• Limits of Confidentiality/Therapy Cancellation Policy

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

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

We are committed to your privacy.  Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.