If you're a new client, please complete the following forms and bring them to your first therapy session.
- Adult Intake/Consent Form
- Child and adolescent intake/Consent Form
- Privacy Policy Consent
- No Surprises Act
- Telehealth Consent Form
- Payment Authorization Form
- Controlled Substances Informed Consent
- Crisis and Harm Reduction Agreement
- Patient Election to Self-Pay
- Revocation of Patient Election to Self Pay
- Safe Harbor Agreement
- Access to Health Records - Notice of Rights Minnesota
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.