Consent Form- Child

Please take time to review this consent form with your child, in order to ensure that you and your child understand what to expect from therapy. I will review this form with you and your child on our first session, in order to ensure you and your child fully understand what to expect from treatment. 

Intake Form

Please review this form before the first intake session. Please answer questions as best as possible for you or your child. I will use the first intake session to gather any additional information, ask clarifying questions, and may seek elaboration from the child and the child's caregiver to get a better understanding of your/child's needs.

No-Secrets Policy

If you will be starting family and/or couple's therapy, it is important to inform you that treatment may be negatively impacted if individual members of the family /couple unit, try to meet with the therapist individually, in effort to share information about others, or anticipate that the therapist can maintain secrets about themselves. Please review this form before treatment to understand this policy, and we will review it together at our first session. 

Authorization to Exchange Protected Health Information (PHI)

In the event that the therapist and client believes it would be beneficial for the therapist to communicate with any third parties, to promote positive movement towards client's treatment goals, the therapist will require that the client and caregiver sign this authorization form, as treatment is confidential. This authorization can be rescinded at any time with written notice. 

Payment Authorization Agreement

Please review this form, and we will review it together, before treatment begins.