Forms & Confidentiality

If you're a new client, please download, print, and fill out some of the following forms;
this can save some time if we have them for your first therapy session.

Click to view the pdf version of forms where you can save/download or print them.

 

​ Statement of Informed Consent         

​ Client Intake Form (Adult)

           As an adult client to fill out - describe yourself, your health, your family, and all relevant information.

pdficon Client Intake Form (Child/Youth)

            Intake form for you as parent or guardian to fill out on your child/youth’s behalf.

 

 Confidentiality In Therapy

 
Confidentiality is taken seriously and is a foundational component of a therapeutic relationship. Your information remains privileged and secure at all times except under the following circumstances where I am mandated by law and have a duty to report:

  • Abuse or suspected abuse of a child under the age of 16
  • If you disclose imminent thoughts of harming yourself or someone else
  • If my clinical notes get subpoenaed by a court
  • If you disclose abuse by a health care provider

These rules apply to all social work professionals.

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