Consent to Treatment
This long document contains very important information about your rights and responsibilities as a client, my fees in detail, my educational background, the therapeutic process, risks and benefits, and my responsibilities as a licensed clinician in Oregon. Please review it very carefully, print and sign it, and bring it it your first visit. If therapy is for more than one individual, please ask each person to sign and date the last page.
Intake Forms
These forms allow me to get to know YOU! Please completely these forms thoughtfully and in full. I will ask you questions in our first appointment as well, but this form gives me a place to start.
If you are an individual seeking therapy, please only complete the Individual Intake Form.
If you are a couple, please complete the Individual Intake Form for each person and then complete the Couples Intake Form for each person as well. If you want to complete the Couples Intake form as a unit, you may do so. Please just indicate “both” in the names. I recommend completing it individually as I can get a better idea of what each person’s thoughts around goals and issues are in the relationship.
If you are a family, please complete the Individual Intake Form for each family member and then complete the Family Intake Form.
For referrals for children/youth, please complete the Child/Youth Intake Form only. If family counseling will occur, please complete the Family Intake Form as well.
Social Media Policy
This is the time of social media! It seems that most people are online and visible to the world. Due to the private nature of our relationship, it is essential that you review this policy. Please print, sign, and bring to your first appointment. Please bring the signed page to your first appointment.
Privacy Practices or HIPAA
This is a typical statement regarding the privacy of your health information. Please review it carefully and print/sign the last page. Please bring the signed page to your first appointment.
Credit Card Authorization Form
Please review this form if you are using a credit card for payment and print/sign/bring it to your first appointment. This form will allow me to collect payment from you in future sessions.
Cancellation Policy
Please review this form closely as it describes my cancellation policy and fees charged in detail. Please print, sign, and bring this form to your first appointment.