Forms

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

• Adult Screen for Co-Occurring Disorders
• Consent & Notice of Private Practices
• Outpatient Demographics
• Cancellation Policy
• New Fee Schedule
• New Client Enrollment
• New Program Rules
• Patient Health Questionnaire
• Notice of Private Practices
• Rights of Recipients
• Referral Form
• Statement of Confidentiality
• WITS Admission 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:

• Release of Private Information

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