Intake Forms
Please complete these forms before your first session. Filling out your paperwork in advance allows us to make the most of your time together and ensures your therapist has the information they need to provide you with the best possible care.
Required Forms
Download Your Intake Paperwork
Click the download button on any form to save a PDF copy. You may print and complete these forms by hand, or fill them out digitally.
Consent for Treatment
This form outlines the nature of therapy, your rights as a client, the limits of confidentiality, and the responsibilities of both you and your therapist. Your signature indicates that you understand and agree to the terms of treatment.
HIPAA Acknowledgement
This document explains how we protect your personal health information in compliance with the Health Insurance Portability and Accountability Act (HIPAA). It describes how your information may be used and your rights regarding access to your records.
Demographic Questionnaire
This form collects basic personal information including your contact details, emergency contact, and demographic information. This helps us provide personalized care and reach you in case of an emergency.
Insurance Information
If you plan to use insurance, please provide your insurance details including your provider name, member ID, group number, and subscriber information. This allows us to verify your benefits before your first session.
Credit Card Authorization
We keep a card on file for copays, coinsurance, self-pay fees, and late cancellation charges. Your payment information is stored securely and is never shared. You may update your card at any time through the patient portal.
Telehealth Consent
If you plan to attend any sessions virtually, this form covers the specific considerations for telehealth therapy, including technology requirements, privacy expectations, and the limits of remote care.
Prefer to Complete Forms Online?
You can also complete all of your intake paperwork through our secure patient portal. After scheduling your first appointment, you will receive a link to access your forms digitally. The portal is HIPAA-compliant and encrypts all of your information.
If you have any trouble accessing the portal, please contact our office at (555) 123-4567 and we will be happy to assist you.
Forms Complete? Let's Get Started
Once your paperwork is submitted, you are all set for your first session. If you have any questions, we are here to help.