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Blue Mountains
Blue Mountains

Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Disclosure Statement
  • Patient Intake Form
  • HIPPA Form
  • Client and Counselor Responsibilities and Rights

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.

Disclosure Statement

 
Patient Intake Form
 

HIPPA Form

 

Authorization to Disclose Information Form

 
 
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Helpful Forms

Click here to view and print forms for your appointment.

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