Informed Consent Documents

If this is your initial appointment with my practice, please complete the following:

• Reason For Visit Form

Choose from the following as per your request for either evaluation or treatment:

• INFORMED CONSENT FOR TELEHEALTH - Treatment/Consultation                                   
                                                    or
• INFORMED CONSENT FOR TELEHEALTH - Evaluation 
  
  

If you would like me to communicate with another provider (for example, your primary care provider or other therapist) please complete the below Authorization to Release Confidential Information form.

• Authorization to Release Confidential Treatment Information