Intake and Consent Forms

If you're a new client, please complete the following 4 forms and bring them to your first therapy session

• Client Therapy Intake Form ( completed form must be brought to your first session ).
• Declaration of No Court Involvement in Middlesex County, NJ ( completed form must be brought to your first session ).
• Notice of Privacy Practices Receipt ( completed form must be brought to your first session ).
• Consent to Treatment and Cancelation Policy  ( completed form must be brought to your first session ).

The following forms are for you to print and review for your records. The following 2 forms do not require completion.

• What To Expect On Your First Visit
• Notice of Privacy Practices

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of therapy information:

• Authorization to Disclose

Note: To download Adobe Acrobat Reader for free, click here .