Here you will find the paperwork we use in the office so that you can have a copy to read and examine before our first session. To save time, print them out and bring them to our first session so we can get right to work.
All clients please print, read, and complete the following forms:
Notice_of_Privacy_Practices (HIPPA) You don’t need to print if you don’t want to, but please read. In the intake packet you will sign that you have read and understand it. There are printed copies in my office as well.
Depending on the work we will do, please complete one of the below Detailed New Client Questionnaires:
Optional Alternative Perspective: Mind Heart Body World Assessment (Do this if it resonates with you. You may need an additional paper)
For couples/relationship work (each person complete individually):
Couples-Relationship New Client Questionnaire (pdf) or Couples-Relationship New Client Questionnaire (Word doc)
For both individual and couples work, drawing a Genogram (map) of your family can be helpful (but not required). Here are Genogram instructions.
Insurance Agreement – If you would like us to bill your insurance company for sessions, this form needs to be completed. Please also bring your insurance card or a copy of the front and back of the card to our first session.
Consent to Release and Retrieve Information – Everything about our work together is legally confidential with a few exceptions outlined in the Disclosure Statement. If you want me to talk to anybody else about our work such as your primary care physician, family, friends, partner, teachers, other therapists, etc… for any reason this form needs to be completed.
I don’t use worksheets in session, but some clients find it helpful to have concrete tools and worksheets to work on at home in between sessions. Here are some resources I use from time to time. Use them if they are helpful to you.
Relating and Connecting Communication Skills
Communication – Needs List
Communication – Feelings List
Shared Vision for Your Relationship
Couples Relationship Responsiveness Questionaire
Owning your Reactions to your Partner
Behavior Change Request Dialogue
Relational Attributes Self-Assessment