After you have scheduled your very first visit with me, please print the following documents, fill them out, and sign them before arriving for your appointment. Completing these ahead of time will allow us to begin on time and maximize the potential for your session.
- Consent for Treatment (Agreement for Services):
- Notice of HIPAA Privacy Practices (How your personal information is used – Sign 1st Page):
- Adult Client Information Form (18 years of age and up):
- Youth Client Information Form (0-17 years of age, guardian to complete):
- Insurance Agreement Form (For clients using their insurance benefits):
- Insurance Opt-Out Form (For clients who decide to opt-out of using their insurance benefits for which I am In-Network):
- Distance/Online Counseling Agreement Form (For established clients who have been screened for this service):
- Releases of Information (For John to be able to coordinate care and communicate with others regarding your treatment)
To view, download, and print these documents, you must have Adobe Reader installed on your computer. Please click the link below to obtain a copy of Adobe Reader.
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