Before we meet:
If you have the opportunity to do so before we talk by phone, please review the following forms:
- OFFICE POLICIES: My Office Policies Form explains my office procedures and agreement for psychotherapy services. This includes important information about your confidentiality. If you have questions after reading this form, please bring them up when we meet.
- SOCIAL MEDIA POLICY and TELEHEALTH POLICY: My Social Media and Telehealth Policy Forms explains my policies and procedures as they relate to our potential interactions via internet, email, telephone, or audio-video based therapy and/or communication. Please let me know if you have questions or concerns about these policies.
- NOTICE OF PRIVACY POLICIES/HIPAA: I am required by law to provide you with a copy of the HIPAA Notice of Privacy Policies so you can understand your rights and protections related to the use and disclosure of your identifiable health care information.
- GOOD FAITH ESTIMATE: For those who choose to pay out of pocket and are not using insurance to cover services with me, you have the right to a “Good Faith Estimate” to help estimate the expected charges you may be billed for receiving certain health care items and services.
- CONSENT FOR IN-PERSON SERVICES DURING COVID-19 PANDEMIC: This document contains important information about in person services in my offices during this COVID-10 public health crisis. Please read this information carefully and let me know if you have any questions. When you sign this document, it will be an official agreement.
After our phone consultation, please print, complete and bring to your first session:
Please bring the signature pages from each of the three aforementioned forms (the final page with your signature on each page from the the Office Policies Form, Social Media Form, and HIPAA Form). If it's easier, feel free to complete the one page "Acknowledgement of Notifications" form and bring it to your appointment. In addition, please complete the following forms: Client Background Information Form, Adult Client Checklist, Consent for In-Person Services, and Authorization to Exchange Information Form (as appropriate). All of the forms are in PDF format.
- CLIENT BACKGROUND INFORMATION FORM: Prior to our first session, please complete my Client Background Information Form and bring it to our first appointment. This form asks you to record basic demographic information (address, phone, etc.), emergency contact information, and insurance information (if applicable). This will also help you share important details with me while allowing our first meeting to unfold more naturally.
- ADULT CLIENT CHECKLIST: Please complete this "checklist" form which may reflect some of the symptoms you are experiencing, and while it sometimes feel reductive, I have found that this "reporting of symptoms" can be helpful in clarifyingwhat may be most important to focus on. Please feel free to write in additional feelings, thoughts, reflections, etc.
- AUTHORIZATION TO EXCHANGE INFORMATION:
There may be times when you and I agree it would be helpful for me to speak with another person to coordinate your care. With the exception of the situations outlined in the HIPAA form, I cannot do this without your written consent. Usually, we will speak about this in person and you will sign the form in my office. However, if you’re unable to meet with me, you may complete my Authorization to Exchange Information and send it back to me.
- CONSENT FOR IN-PERSON SERVICES during the COVID-19 Pandemic: See above for full description.