Intake forms for THERAPY clients (please select your respective therapist from the dropdown menu for each form):

New client information & consent for services

     To be completed for all new patients

Evaluation Acknowledgement

     To be completed for all new patients

Privacy notice

     To be completed for all new patients

Credit Card Authorization

     To be completed for all new patients

Adult – background & history

     To be completed by patients over the age of 18

Couple – background & history

     To be completed by patients over the age of 18

Adult – permission to release information

     To be completed by patients over the age of 18

Eating Disorders/Disordered Eating Addendum

    To be completed by clients or the parents/guardians of minor clients dealing with eating disorders or dysfunctional eating

Perinatal Addendum

    To be completed by patients over the age of 18

Minor – background & history

     To be completed by the parents or guardians of children under age 18

Minor – permission to release information

     To be completed by the parents or guardians of children under age 18