OFFICE FORMS

The following forms and handouts are in PDF format. If you do not have a PDF reader such as Adobe Acrobat Reader, you may download one here for free. You may fill out the form online and print OR you may print the form and fill it out by hand.

For your first visit, you will need the First Appointment Information Form and a Fee Agreement. If you want your doctor to discuss your treatment with anyone such as a family member or a family physician then you will also need to complete a Consent Form. It is also important that you review and sign the HIPAA Privacy Notice.

First Appointment Intake form -basic information form for first visit.( (PDF-file)

Fee Agreement - Agreement explaining fees and specifying how you plan to pay for services.(PDF-file)

Consent to Release Information Form -This form gives permission to release records or speak to someone, such as your family doctor. No information is ever released without written, signed, permission to do so. The form allows you to specify the exact information you would like released or discussed.( PDF-file)

HIPAA Privacy Notice and Office Policies -- This form explains how your private health information may be used and explains some of our office policies. (PDF-file)

Welcome Brochure--Outline of general practice information and office policy (PDF-file)

Gottman 17-Areas Questionnaire-Questionnaire for couples entering couple counseling (PDF-file)

Marital Questionnaire Packet -Second packet of questionnaires for couples entering couple counseling (PDF-file)

What is Psychological Testing? - General handout describing psychological testing.(PDF-file)

Suggestions for Simple Insomnia(PDF-file)

Scientific American Article on Stress(PDF-file)

How to Choose a Therapist(PDF-file)