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INTAKE FORM

 

This completed intake form is needed for the first session.  

Please make sure to bring it with you - fully completed.

Feel free to make a front and back copy of your insurance card if you are using insurance. Or please bring your insurance card so that I may copy it when you arrive.  

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If client is a minor in a split custody case, both custodial parties must sign the "Welcome To My Practice" and "Primary Care Physician Consent" sheets.​

This Disclosure of Information form is also needed for the first session.

 

If client is a minor, please also complete the Child Intake Addendum Form.

Can't find the other forms?

<--Click here.

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