Individual Therapy - Adult New Client Forms
For ease of access and to reduce paper consumption, all new client forms are web-fillable. Please complete and sign the following paperwork before our first intake appointment. By clicking the links provided below, you will be redirected to an end-to-end encryption platform, FormHippo, to ensure protection of your privacy. FormHippo will ask for your email address and send you a specialized code to sign each document. If you do not receive a code, try checking your spam folder. Please complete all forms and do not hesitate to reach out should you have any questions or concerns.
[Insurance Specific] If you plan on using your health insurance to obtain services, please complete the following additional form:
[Telehealth Specific] If you plan on using remote therapy services via video or telephone, please complete the following additional form:
Good Faith Estimate (GFE)
As required by law, if you are paying for services out-of-pocket (self-pay), you are entitled to receive a Good Faith Estimate (GFE) outlining the expected costs. You will receive a personalized GFE based on the specific services you will be receiving. Along with your personalized GFE, I am providing an updated list of my current professional fees below for your reference.
Good Faith Estimate (GFE)
As required by law, if you are paying for services out-of-pocket (self-pay), you are entitled to receive a Good Faith Estimate (GFE) outlining the expected costs. You will receive a personalized GFE via email based on the specific services you will be receiving. Along with the GFE, I am providing an updated list of my current professional fees below for your reference.