NEW CLIENT INTAKE

Please print and fill out the following patient information and medical history forms at your convenience.

HIPPA CONFIDENTIALITY FORM

This notice describes how psychological and medical information about you may be used and disclosed and how you can get access to this information. Please review it carefully.

START TO MAKE MEANINGFUL CHANGE TODAY

Together we can make tomorrow brighter.

CONSENT TO RELEASE INFORMATION

This form when completed and signed by you, authorizes me to release protected information from your clinical record to the person you designate.