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Forms
If you’re a new client, please complete the following forms and bring them to your first therapy session:
New Patient Form, Notice of Privacy Practices Acknowledgment Form
New Patient Form, Notice of Privacy Practices Acknowledgment Form
New Patient Form
Notice of Privacy Practices Acknowledgment Form
Read our Notice of Privacy here ➜
Medical Record Request
Informed Consent for Telehealth
Consent to receive Correspondence From Sweeney Dawley Recovery Center
Credit Card Authorization Agreement
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize the release of psychotherapy information:
Authorization for the Release and/or Discussion of Protected Health Information