Forms & Documents

For your convience you may download and fill out these forms prior to
your office visit.

These document are in PDF format and may require you to download and install Adobe® Reader (free).

1. Counseling Services Applicaiton

Basic personal and contact information.

2. Counseling Description of Services

Please read carefully through the following information and sign at the bottom.

3. Notice of Privacy Practices

Heath Insurance Portability and Accountability Act (HIPPA). This notice will tell you about the ways in which I may use and disclose health information about you and will describe your rights and my obligations regarding the use and disclosure of that information.

4. Authorization for Release of Confidential Information

Please read and fill out the authorization form carefully.