If you are coming in to see me for a first appointment, you can expedite the paperwork process by printing my intake paperwork from this website, filling it out, and bringing it in with you. Click on the links below to download the intake forms.
Administrative The Administrative form requests demographic, contact, and billing information.
Insurance The Insurance form explains what information my billing service will need to bill your insurance company. In order to fill this form out, you will need to call your insurance company or visit their website. Most insurance companies cover mental health and substance abuse, but sometimes that portion of the plan is covered by a different entity than the company that covers “medical” illnesses. When you verify your benefits, make sure to call the number on your card for mental health/substance abuse services or to inquire about mental health benefits specifically when you call the main number.
If you are interested in couples or family counseling, ask whether those services are covered. Many insurance companies will not cover couples therapy but will cover family therapy. You may want to ask your insurance company how they distinguish one from the other.
Clinical The Clinical form asks about personal and treatment history, substance use, and goals. If you are coming in with a partner, you should each fill out a Clinical form.
Medical The Medical form is for recording health problems and medications, and provides an option for you to allow me to coordinate treatment with your psychiatrist or primary care doctor. If you are coming in with a partner, you should each fill out a Medical form.
Policy Statement My policy statement covers your rights as a client, fees and billing, no-shows and cancellations, how to reach me in an urgent situation, and termination of therapy. State law requires me to inform you of these things, so I need your signature on the last page of my policy statement to demonstrate that I have done so.
Map & Directions to my office