Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

• Clinical Referral Form
• Psychiatric Rehabilitation Program Referral Form (to be completed by treating licensed therapist only)
• Therapeutic Behavioral Services Referral Form (to be completed by treating licensed therapist only)
• Therapeutic Behavioral Services Face Sheet (must accompany referral form)

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:

• Release of Information
• Consent for Treatment
• Privacy Practices
• Client Rights, Responsibilities and Protections

Note: To download Adobe Acrobat Reader for free, click here.