Intake Forms:
There are 8 intake forms that you need to be read and complete prior to our first meeting.
Please print out these forms, complete them and bring them with you to your first appointment.
- Notice of HIPAA Privacy Practices (Information for you to read and optional to print).
- Notice of Privacy Practices, Reciept and Acknowledgment of Notice (Please print, complete, sign, and bring in with you).
- Policy Guidelines and Services Notice (Please print, read, sign, and bring in with you).
- Payment and Insurance Form Notice (Please print, complete, sign, and bring in with you).
- Problem Rating Form PHQ-SADS Notice (Please print, complete, and bring in with you).
- Adverse Childhood Experience (ACE) Questionnaire (Please print, complete, and bring in with you).
- History Form Notice (Please print, complete, and bring in with you).
- Electronic Communications Policy (Please print, read, and sign. Bring in with all other intake forms).
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Behind the hardness there is fear
And if you touch the heart of fear
You find sadness (it sort of gets more and more tender)
And if you touch the sadness
You find the vast blue sky
Rick Fields
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