Please select the proper intake form to complete and bring with you for your scheduled appointment. It is recommended you print and complete the intake form to bring with you to your initial appointment.
If you would like us to coordinate care with your psychiatrist, primary care physician, or your child's school, please use our Authorization to Disclose Information Form below to grant us permission to do so. You can bring this form to us during your next office visit.
Per company policy, clinicians or office staff are not permitted to speak to your attorneys with this form. All legal representatives must secure a subpoena to speak with a member of our practice. See our agreement for associated fees for communicating with attorneys and related court retainer fees.
Your mental health record is accessible to you upon request. If you request a superbill (summary of receipts) or a copy of your records, there is a $45 administrative charge for the first 20 pages and $1 per page thereafter. If you are being seen as a couple, two copies will be given to each separate client. You are allowed one free mental health record per year when your request is mailed directly to a government agency.
Note: To download Adobe Acrobat Reader for free, click here.