Individual Therapy - Minor 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 access each form. 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.
[Optional] 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, please complete the following additional form:
The documents below are for your reference only, you do not need to sign anything.
By law, if you are not using your health insurance to obtain services then you are entitled to a good faith estimate. The following document estimates maximum charges allocated based on my current out of pocket full rate fees for individual therapy. This document is created to represent transparency in pricing and it does not constitute a contractual agreement. In addition to the good faith estimate, I am also including an updated list of my current professional fees for services.
The documents below are for your reference only, you do not need to sign anything.
By law, if you are not using your health insurance to obtain services then you are entitled to a good faith estimate. The following document estimates maximum charges allocated based on my current out of pocket full rate fees for individual therapy. This document is created to represent transparency in pricing and it does not constitute a contractual agreement. In addition to the good faith estimate, I am also including an updated list of my current professional fees for services.