These forms are for patients who have already scheduled a first appointment. Nothing here is required before your initial phone consultation — that remains a conversation, with no paperwork.
Once your first session is scheduled, please complete these in advance and bring them with you. This lets us spend that time on clinical work rather than paperwork.
How to use these
Download, print, and complete by hand. Bring the completed forms with you to your first appointment.
Please do not email them back — ordinary email is not a secure way to send health information.
Parents of Adolescent Males (16–17): Start Here
Adolescent Males: Parent/Guardian & Client Registration and Consent
Required before the first sessionFor parents and guardians of an adolescent male, ages 16 and 17. Covers consent, fees, the cancellation policy, and what is and is not shared with parents. Your son signs it too. If parents share legal custody, both are asked to sign.
Also required: the Notice of Privacy Practices (below). If any sessions will be by video, also complete the Telehealth Informed Consent (below).
Individual Therapy (Adults 18+)
Patient Registration & Consent
Required for adults 18+Your contact information, emergency contact, and consent for treatment. Covers fees, the cancellation policy, and confidentiality.
Notice of Privacy Practices
RequiredHow your health information is used and protected under HIPAA, and what rights you have regarding your record. You sign only to acknowledge receipt.
Telehealth Informed Consent
If seeing me remotelyRequired only if any of your sessions will be conducted by video. Covers privacy, technology, licensure, and emergency procedures for remote sessions.
Failure to Launch Family Consultation
Family Consultation Registration & Consent
Required for family consultationsFor parents and families scheduling a consultation about an adult son. Covers the scope of the consultation, fees, and confidentiality. If two family members are attending, both should sign.
What About the Cost Estimate?
Federal law entitles you to a written Good Faith Estimate of what your care is expected to cost. Because that estimate has to reflect your particular situation, it is not a blank form to download — I prepare it individually and provide it to you before we begin.
If you have scheduled an appointment and have not received your Good Faith Estimate, call the office at (609) 439-6526 and I will send it to you.
Questions
If anything on these forms is unclear, leave it blank and we will go through it together at your first session. Nothing here needs to be perfect before you arrive.