Privacy Policy & Client Information Forms

Please read the privacy policy and client information forms linked below. Complete all of the forms and bring them to your first session. If you would like me to coordinate care with another provider (for example, your psychiatrist, another therapist, etc.), be sure and complete the Release of Information form.

Please note that my office is a fragrance free zone for those of us who have allergic, asthmatic or respiratory concerns.

Privacy Policy:

The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.

Exceptions include:

  • Suspected child abuse or dependant adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
  • If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
  • If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.

Client Intake Form

(opens in new window)

Client Info & Consent Form

(opens in new window)

Credit Card Authorization Form

(opens in new window)