Instructions:

Please print the Initial Client Intake Form and complete it prior to your first appointment and bring it with you. If you are not able to complete the form prior to the initial intake, notify Therese and she will provide the paperwork for you to complete 20 minutes prior to your initial meeting. We are able to make accommodations if you need assistance filling out the forms. The additional forms are for you to keep and review. Please contact Therese if you have any questions regarding the forms prior to your first visit. Thank you.

FORMS:

Initial Client Intake Form
AUTHORIZATION FOR USE OR DISCLOSURE OF PROTECTED HEALTH INFORMATION for me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.):

NOTICES:

HIPAA Privacy Act

Obtaining legal consent for child and adolescent counseling evaluations

List of State Agencies

What to Say to Your Child about Seeing a Therapist

Arizona Client Rights Statute