Questionnaires
If you are coming in for assessment or bringing your child in for assessment, please fill out one of the following questionnaires (Children or Adult version) and bring it to the first appointment:
Privacy Forms

Release/Exchange of Information (only print if specifically instructed to do so) | |
File Size: | 203 kb |
File Type: |

Consent to Treat Minors of Divorced Parents | |
File Size: | 40 kb |
File Type: |

Consent to Treat Minors of Divorced Parents | |
File Size: | 28 kb |
File Type: |
Credit Card Authorization Form
Some parents prefer that their children do not carry a credit card to appointments. You may prefer to provide me with credit card information. I will keep this information in a locked file cabinet and charge at the time of services.

Credit Card Authorization Form | |
File Size: | 31 kb |
File Type: |