Helpful Forms

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

1. Patient Information

2. Notice of Privacy Practices

Client Psychotherapy Intake Form

4. Therapy Cancellation Policy

5. Limits of Confidentiality

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:

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

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Troy Michigan and the Surrounding Areas