We will speak by telephone to discuss the concerns that bring you to counseling. When you decide to schedule an appointment, I’ll give you the option to use my streamlined system, to save us time: I’ll ask you to provide me with your email address, and a user name and password that you will remember. Then I’ll send you an email which will guide you through entering this information in the “appointments” section of my website. My clients are delighted with my new system, as it gives us more time in our session to discuss your concerns.
For those of you who don’t want to use the new system, here is the old fashioned way: in preparation for our first meeting, please download, complete and sign these two forms (the Client Service Agreement, and the Acknowledgement Form.)
1. Client Service Agreement: this explains my office procedures and agreement for psychotherapy services. This form includes important information about your confidentiality. Please don’t hesitate to ask me any questions which you may have.
If you will be using insurance, please complete Client Service Agreement For Clients Using Insurance. When completing this form, please refer to the Insurance section on this website, so that you can ask your insurance company all the necessary questions before we meet. This will reduce the risk that you will be responsible for the full session fee.
If you will NOT be using insurance, please instead complete Client Service Agreement For Clients NOT Using Insurance.
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I am required by law to provide you with a copy of the HIPPA Notice of Privacy Practices so you can understand your rights and protections related to the use and disclosure of your identifiable health care information. At your option, you may read this online or download and print it for your review.
2. Acknowledgement Form: this First Session Acknowledgement Form states that you have access to and have read all forms. Bring this to our first session as well.
Forms for Subsequent Meetings
1. Background Questionnaire: Prior to our second appointment, please complete this Adult Background Questionnaire, which will provide me with some of your background and history. (This is not necessary if you have used my new streamlined email system, above.)
2. Authorization to Release Information. In the future there may be times we feel it would be helpful for me to speak with another person (to your physician, for example), in order to coordinate your care. Typically, we will discuss this in person and you will sign the form in my office. However, if you’re unable to meet with me, you may complete the Authorization for Release for Individuals, or Authorization for Release for Couples, and mail it to me.