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Green Hills with Blue Sky

Helpful Forms

Please read:

Once you have had a chance to have a free consultation, these forms need to be filled out before our initial scheduled therapy session. Please print and fill out then either scan or take a picture and email to me directly: allisongold@solutionsSupport.org

1. Client Psychotherapy Intake Form

2. Limits of Confidentiality/Therapy Cancellation Policy

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 psychotherapy information:

3.Authorization to Disclose Information Form

 

Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  

 

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

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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Helpful Forms

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