1. AGREEMENT AND INFORMED CONSENT FOR TREATMENT
This MULTI-PAGE form gives you specific information about my office procedures and your agreement for psychotherapy services. It also includes important information about your privacy and confidentiality. Please read, sign and return it as well as print and keep a copy for yourself. If you are being seen as a couple, you BOTH should sign this form.
Download the Informed Consent PDF form
2. CLIENT INFORMATION SHEET
Please print the one-page client information sheet, fill it out and bring it with you to your appointment. If you are coming for couples’ therapy, EACH of you should complete a separate copy of this form.
Download the PDF Client Information Form
3. HIPAA FORM TO READ AND KEEP FOR YOURSELF
I am required by law to provide you with this Oregon Notice of HIPAA Privacy Practices so that you understand your rights and protections as they relate to the use and disclosure of your identifiable health information.
Download the PDF HIPAA Form
Please review the Health Information Privacy Act statement. Signing my Agreement and Informed Consent form acknowledges that you have ALSO read this HIPAA form.