I am looking forward to working with you. To prepare for our first meeting, there are a few forms that I need you to complete and get back to me before your appointment: (1.) “Client Information Form,” (2.) “Service Agreement,” and (3.) “Informed Consent Agreement for Teletherapy.” Directions and links are found below.
Please read these instructions carefully. It will help me to move more quickly toward helping you!
Client Information Form:Please click on the “Client Information Form” link below and print. Complete each of the items on this form. If you have questions about an item, skip over it and we can discuss it when you meet. If you are coming for couple counseling, each of you should complete your own form. This information is very important to our work together, so please take the time to complete fully.
Service Agreement: Please click on the “Service Agreement” link below and print. Please take the time to review this document carefully. I know that it is lengthy but your thorough reading of this agreement will be very helpful to each of us as it describes what you and I can expect from one another in the counseling relationship. There are several areas within the Agreement for you to place your initials and to date within this agreement. At the end of the agreement, you will see an area to print and sign your name, followed by the date. If you are seeking couple counseling, only one printed Service Agreement is needed that each of you should initial and sign.
Informed Consent Agreement for Teletherapy: If we are doing Teletherapy, review and sign this form. If you are seeking couple counseling, only one form is needed and that each of you should sign.
Sending these forms to me: You will need to scan these forms and email to me or send via US mail or drop off at my office. I will send an email to you when we set our first appointment using MedTunnel, which is a secure, encrypted and HIPAA compliant email service. I will use your first name as a password. You will need to create your own free account to use to send these forms to me. You may also choose to send using your personal email account to me but if you do, you must know that regular email is not a secure form of communication and that it is possible that someone may access your forms before they reach me.
Privacy Practices:I am required by law to provide you with a copy of my privacy practices for you to keep. You will find a link to this document below. In the Client Service Agreement, your signature will attest that you have received a copy of the Privacy Practices. There is no need to sign this form or return to me.