Intake Packet Forms

I know that the list of forms below looks like a lot.  I want you to know that careful thought was put into each and every document to only include, in the case of the policy paperwork, the information that I am required to provide you by law and that explains the policies that my practice follows.  The clinical paperwork is all designed to help me get to know you better and focus our conversation in the first session on the items that are most important to you.  You are welcome to complete these forms ahead of time or to arrive 15-20 minutes early and work on them before our session.

 Please let me know if you have any questions at all.  

To learn about different ways to return the completed forms to me in a secure/private manner…
Go to: Returning Completed Forms
NOTE: Regular e-mail is not secure and I cannot guarantee your privacy on it’s internet travels between you pushing “send” and it arriving in my inbox.  Once it is in my possession, I will keep it private from that point forward.

Crisis Resources

• Crisis Resources (What to do if you are having an emergency when you are my client)

Welcome Letter

• Adult & Teen Letter
• Parent Letter (for child clients)

Policy Paperwork

• Intake Document Summary (Definitely read this, for those of you who aren’t into the “fine print”)
• Signature Page for: Consent to Treatment/Financial Policy/Communication Policy/HIPAA (print & sign)
• Consent to Treatment (for your review, print if you want a copy)
• Financial Policy (for your review, print if you want a copy)
• Communication Policy (for your review, print if you want a copy)
• HIPAA Policy (for your review, print if you want a copy)

Clinical Paperwork

• Client Information Sheet (either print and complete OR save completed version and send file to me)
• Background Screening   (Print and complete one of the two below.)
  • Youth & Adult Form for 13+  (either print and complete OR save completed version and send file to me) 
  • Children’s Form for 12 and under (parent completes)
• Developmental Screening (print and complete if client is under 18)
• Self-Report   (print and complete one of the two below, unless client is under 12)
  • Adult for 18+
  • Youth for 12-17