Client Forms

Read-only documents for all new clients:

• Notice of Privacy Practices (read thoroughly)

• Notice of Right to Receive Good Faith Estimate (read only)

Paperwork to complete for all new clients:

 Please bring thoroughly completed paperwork to your first appointment.

• Client Intake (complete thoroughly)

• Good Faith Estimate (print, read & bring)

• Personal Disclosure Statement & Consent For Treatment (print, read thoroughly & sign)

Extra paperwork for all couples:

 For those attending as a couple, please complete the following documents (additional to those above). 

• No Secrets Agreement (print one)

• Informed Consent to Record & Release (print one)

• Authorization to Share PHI Between Partners (print two)

Optional forms:

• Request for Non-secure (unencrypted) Communications

• Authorization to Release PHI (optional if coordinating care with others providers, fill & sign)

• Request for Confidential Communications (for those in circumstances where personal privacy is compromised)