Client Forms

If you are new, please feel free to fill out these intake forms before our first session. These forms can also be filled out during the first session. You may also scan the document once you have filled it out and email it to me at

Please print and fill out forms 1, 2, 3, 4 and 5. Return them to me, either by email or bring them to your first session.
  1. Acknowledgment of Notifications
  2. Informed Consent and Office Policies
  3. Limits of Confidentiality
  4. Client Contact and Intake Form
  5. Telepsychology Consent Form
  6. Request to Receive a Copy of the Client Record
  7. Notice of Privacy Practices
  8. Authorization to Release Information
  9. Communications Policy
  10. Automatic Thought Record
  11. Sleep Diary
  12. Email and Texting Risk Questionnaire
  13. Outdoor Consent