Forms and Documentation

I have a client portal where you can digitally and securely complete the documentation I use in my practice. You can access that portal and complete the documentation by going to the Simple Practice Client Portal page and creating your account. These forms are listed here so they are always available and so that you can review them and know what to expect. The forms here are for a range of therapy options, including individual therapy, relationship therapy, and assessment and you wouldn't need to complete them all. They are intended to be a reflection of you, and you can complete them in any way that best represents your identity, history, and experience.

Client Portal - Click here to access my Simple Practice client portal.

 

For reference, the links here go to PDF versions of the forms I regularly use to support the work we might be doing together. These forms do not need to be completed in this format and exist here so you can review them any time without signing up or logging in to anything.

Informed Consent Forms

I have several informed consent forms that we can use to acknowledge different policies for the different ways we might interact, such as individually, for assessments, with couples/relationship therapy, and on and on. My general policies remain the same, and might be adjusted to acknowledge the particular aspects of each type of service. You will likely not need all of these forms, and you don't have to read or review the ones that aren't relevant to you.

Informed Consent for Psychotherapy- Please read this document before completing the signature page. It describes information about confidentiality and my therapy policies. If you have any questions about these policies you are welcome to ask. 

Informed Consent for Couples/Relationship Therapy - Please read before completing the signature page.  It describes information about confidentiality and my relationship therapy policies. If you have any questions about these policies you are welcome to ask. 

Informed Consent for Assessment- This form is for people specifically seeking evaluations outside of receiving therapy. It describes information about confidentiality and my evaluation policies. If you have any questions about these policies you are welcome to ask. 

Informed Consent for Outdoor Session Therapy- We have the option of meeting outside for therapy sessions, once I return to the office. This form is for folks who choose this option, and it covers the specific factors involved with meeting out of the office. Outside sessions are optional, and we can include this form if you want to explore trying this out. If you have any questions about these policies you are welcome to ask. 

Informed Consent for Telehealth - This form describes the benefits and challenges of telehealth. I meet with people in my office by default when possible, and we can also choose to use telephone or online video sessions at times where we choose to do so.

Informed Consent for Covered Therapy- This form is for people specifically seeking covered, back-up therapy outside of receiving their regular, ongoing therapy. Covered therapy is usually arranged directly between me and another therapist and helps to provide urgent or reserve care if your therapist is ill or away. In some situations, I might talk to a person directly and then connect with their therapist to create a back-up therapist plan. It describes information about confidentiality and my covered therapy policies. If you have any questions about these policies you are welcome to ask.

Fee Forms

Fee Agreement- This page confirms our fee and is a review of my fee and payment policies. Please let me know if you have any questions about any of this information, and I am happy to discuss any aspect of this process with you.

Adjusted Fee Agreement- This page confirms our fee when using a reduced rate, and is a review of my fee and payment policies. Please let me know if you have any questions about any of this information, and I am happy to discuss any aspect of this process with you.

Good Faith Estimate- This is an estimate of the fees you will pay over time, based on a yearly estimate, as well as estimates for assessments. We can always adjust the time and frequency of our work, and this is intended to clarify potential yearly costs.

Additional Forms

These are the remaining forms I use in my practice.

Social Networking and Contact Policy - This document describes my policies on how we can communicate around and in between sessions, and on how I interact with social networking sites.

Privacy and HIPAA Information - I am required to provide you a copy of this description of your privacy rights. This form describes the basic rights  for privacy created and dictated by HIPAA.

History and Information - This is a description of your past and current experience in a variety of contexts.

Couples/Relationship History and Information - This is a description of your past and current experience in a variety of contexts. Each partner fills it out for themself, and you can do it separately or together.

Release of Information - This form is used in the event that you would like me to speak to another person about your history or treatment. In the case that you would like this to happen, we will sign this form together and review exactly what you would like communicated. Any other aspects of your treatment or life will remain confidential.