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Primary Forms To
facilitate the best use of the initial intake and evaluation session please download and complete the following forms prior
to your appointment.
Policies and Procedures: This document contains important information about Susan's professional
services and business practices. It must be reviewed and signed.
Additional Forms Authorization for Release of Information: This form must be completed and signed if you would like for Susan to
speak to another person regarding your treatment. This may include a
psychiatrist, another therapist, an attorney, a close family member, a
medical professional, etc. With a firm commitment to confidentiality, Susan will not acknowledge anything about your
treatment, including whether or not you are even in treatment.
Consent to Treat a Minor: form must be filled out before providing treatment to a minor client (less than
18 years old) by any parent or legal guardian who has legal custodial
rights for the minor client. Upon occasion, especially in cases where
litigation is a concern, Susan reserves the right to request a copy of
custodial documentation to be included in the client file.
HIPAA form: please sign acknowledgment of receipt of notice of HIPAA.
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