Forms For Starting Therapy With Me

Here are forms you will need to start therapy with me. Please print them, fill them out, and sign them. During the COVID-19 period in which therapy is remote and not at my office, the easiest way to return the completed forms to me is by scanning them to your computer and then attaching them to an encrypted email to me (see next paragraph). Alternately, you can deliver hard copies to my office and slide them under my waiting room door. (6409 Odana Rd., Suite #23, second floor.) 

Secure email communication can be initiated by completing the contact form at the bottom of this or other pages of my website. Once I get your submitted form, I will email you back with a secure email, and then you can attach the forms to your response to that email, and they will be encrypted. If this is confusing or you have any questions, don't hesitate to leave a message at  608-271-8799, and I'll walk you through the process. 

Treatment and Financial Contract

Demographics Form

Informed Consent

Notice of Privacy Practices

Receipt of Notice of Privacy Practices

Consent for Email

Consent for Remote Electronic Sessions

Clients starting couples or marital therapy will also need to complete the following form:

Confidentiality Agreement - Marital /Relationship Therapy

LOCATION

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