Counseling Forms

FIRST Visit Forms

Below are a list of forms I need you to complete and bring to your first session. Place your cursor over the form and click. A PDF will be provided for you to print.

• Intake Information

• Counseling Contract

• HIPPA

• Declaration of Understanding - East Side

• Personal Health Questionnaire

• Adverse Childhood Experiences

Additional Forms

Below are a list of forms I may recommend you fill out and bring to your next session. Place your cursor over the form and click. A PDF will be provided for you to print.

• Adult Attachment Interview

• Civilian PTSD

• Consent for Treatment of a Minor

FEES

I have a fee of $120 per therapy hour (50 mins). I use an app called IVY for receiving payment for my services. I use your phone number to enter your information into the IVY app. The app sends you a text for services rendered. You put your payment information into the app and I receive payment. In future sessions I will use the IVY app for payment after each session. If you have any questions please ask me.