Forms

I believe it is important to spend your first appointment focusing on what you’d like to talk about.  To maximize our time together, please download and complete the following forms prior to your first appointment.  If you have any questions or need clarification, please don’t hesitate to call.

Required Forms:

•  Contact Form

•  My Office Policy

  HIPAA – Notice of Privacy Practices

For Beacon Referred Patients:

•  Insurance Information Form

Optional Forms:

If you’d like to share more about yourself, please fill out one of the forms below. You do not have to fill out the entire form, just what you are comfortable sharing.

•  Individual Adult / Couple Questionnaire

•  Adolescent Questionnaire

The following forms are to be completed and signed only as needed:

•  Consent to Release Information

•  Authorization to Pay by Credit Card

Thank you and I look forward to meeting with you.