Forms

Intake and informational forms are available here so that you may download, read, and complete them at your convenience.

Confidentiality is a foundational principle of psychotherapy. For this reason, please do not email completed forms to me. You may complete the forms on the computer, then print them out and bring them to the office. If you prefer, you may print out the blank forms and complete them by hand.

These forms are in pdf format and may require Adobe Acrobat to view. Acrobat is available free here.

Some browsers do not support filling forms. Google Chrome supports filling pdf forms, and is available free here.

Client information form — please fill out this form as completely as possible. It will help us use our first session more productively, and may help you clarify what your goals for therapy are. If you are unsure about any of the questions, please feel free to discuss this. (You can fill this out on your computer, if you like, and then print it. Please do not email, for privacy reasons.)

New client informed consent — this form acknowledges that you have carefully read and understand the policies and procedures related to my practice.

HIPAA notice — provides information on the rules and practices that maintain the privacy of your health records.

Release Form — Under some circumstances you may wish to share information about your therapy, for example with another health care provider. This information cannot be shared except with your explicit permission, which you can give through this form.

Call to arrange a free consultation
(510) 858-9950

I look forward to hearing from you!