Intake Documents

To ensure a relaxed and comfortable first visit together, please consider printing and completing all forms beforehand.

Our appointment will focus on the direct assessment of your child, building a therapeutic relationship, and reviewing and clarifying written information as appropriate.

Clinical Intake Form

Consent to Treatment

Consent to Telehealth Visits

COVID 19 Policy

Credit Card Authorization Form

Good Faith Estimate Packet

(Please complete GFE packet only if your clinician is OUT-of-network with your insurance carrier)

Insurance Form

(Please complete insurance form only if your clinician is IN-network with your insurance carrier)

Missed Appointment Policy

Notice of Privacy Practices

Release of Information Form**

**Please complete several separate copies of the RELEASE OF INFORMATION form for:

-Your child’s SCHOOL

-Your child’s PEDIATRICIAN

-Other THERAPY PROVIDERS your child has seen (ie. Occupational Therapist, previous counselors) if applicable

-Your child’s PSYCHIATRY PROVIDER if applicable

-Any OTHER ADULT you authorize to transport your child to therapy, or to communicate about your child’s therapy with the clinician, if applicable