At the time of your first appointment, you will be asked to read and complete several forms related to beginning therapy at my office.  These forms provide important information about therapy in general, privacy and confidentiality, business policies, etc.

If you’d like, print and complete the following forms and bring them to your intake appointment.  If the forms do not automatically open when you click the links, you may need to download the free Adobe Reader, visible on the right, so your computer can access these forms.

You are certainly welcome to arrive 15 minutes before your appointment time to fill these forms out in person.

Adult Registration Form

Outpatient Service Contract

HIPAA Agreement

Contract & HIPAA Signature Page

Patient Registration Sheet

Adult Initial Questionnaire

The following consent forms are specific and required for video therapy sessions or telephone therapy sessions:

       Teletherapy Informed Consent – Video

       Teletherapy Informed Consent – Telephone

If you want me to communicate with other healthcare professionals with whom you work, complete this form and we will discuss it in our next meeting.

Authorization to Release Mental Health Information

Any questions about the forms? Call me at 708-620-2829 or email me using the form below.

Contact Me

For an added level of privacy, please do not include sensitive information in your email message. More sensitive information can be discussed by telephone or face-to-face.