Forms

I now use an online portal for new patient intakes, please wait for an invite to the portal to complete forms. 

If you are already a patient and need the link to the patient portal again, here you go: Portal Login

If you are already a patient and forgot your password to the portal, send me an email or contact from the website saying as much.  I will send you a link to reset it.

Other forms often needed:

Permission to Release Information

Legal Fee Agreement

Forms often used in Clinical Supervision:

Supervisee Evaluation

Clinical Supervision Contract (for private, in-office supervision)

Group Supervision Contract (for group, outside supervision)

Supervision Face Sheet

For ASW’s:

Sample letter for Supervision from Outside Employer

ASW Supervisory Plan

Responsibility Statement

Experience Verification

For AMFT’s:

MFT.responsibility statement

Weekly Log (option 1)

Weekly Log (option 2)

Experience Verification (option 1)

Experience Verification (option 2)

Miscellaneous Forms and Documents:

Release of Information

Substance Abuse Policy

Report of Suspected Dependent Adult Elder Abuse

Suspected Child Abuse Report

VA Choice Cancellation Policy