Intake Packet

Please read the Psychologist-Patient Agreement and COVID-Policies, as a signature is required indicating that you have read and agreed to follow the terms and conditions. Please download and complete the intake card and mail or bring it to your first appointment. Please send a copy of your insurance card (front and back) or bring it to your first session.  Feel free to ask your therapist any questions about these policies.

If you wish for communication between your therapist and primary care physician, please also complete the PCP Release Form. If there is anyone else with whom you would like your therapist to obtain or share information (previous therapist, school, other past or current treating provider), please complete a separate Release of Information Form for each organization or individual.

The following surveys ask questions about how you/your child felt in the last two weeks. If you/your child are comfortable, please complete them. They are helpful in understanding your symptoms.
Form for Adults
Self-Rate Form for Children Age 11-17
Parent Form for Children Ages 6-17