The first two forms below are ones that you will need to fill out either during or prior to our first session.
If you are able to print out the second one and complete it in advance, it will save time in our first session in order for me to begin getting to hear and explore the specific issues that bring you to therapy sooner.
The first of these forms - Informed Consent – must, by law, be understood and signed as the first thing we do before we commence actual therapy. This is an aspect of consumer protection, to guarantee that you are fully informed about your rights and responsibilities as a client, and any limitations on those rights, which apply by law to all therapy settings. Please make sure you understand all its information or make note of anything you wish to question me about before signing, which will be the first thing we do in our first session.
Informed Consent (incl. Confidentiality & Session Cancellation Policies)
The second is a 2-page Client Information Form ("initial intake"). This factual contact and health information is important for me to receive at the first session. I will have a blank form on a clipboard in the waiting room for you if you wish to arrive 5-10 min. early and fill it out before we first meet. Or you can print it out from this link and fill it out to bring with you:
Client Information Short Form (initial intake)
The third form is a longer "getting to know you" questionnaire that can be filled out over time and is optional. You may wish to postpone answering some of its questions until you feel more comfortable or have more time to reflect on them. But even just reading over this Client History & Self-Assessment questionnaire can be fruitful, whether you fill it out or not, as it may bring to mind some aspects of your life experience that could help you think of potentially connected issues that impact what brings you here.
Client History & Self-Assessment Questionnaire(optional)
If, at any point in therapy, you would like me to coordinate care with another provider of your health care (psychiatrist, primary care physician, etc.), please complete this form to authorize release of psychotherapy information:
Client Authorization to Disclose Information Release Form
The next two documents provide further information for you about professional therapeutic boundaries and your rights as a client.
The first is the HIPAA Notice of Privacy Practices, which informs you more broadly (beyond the issue of authorization) about your rights, choices, responsibilities, and the therapist's duties and responsibilities in your regard.
The second document is provided by the California Board of Behavioral Sciences (BBS) as an information booklet regarding a particularly egregious violation of therapeutic practice in a domain where all clients should know their rights and the definitions of appropriate professional boundaries:
Finally, the following document may be of interest to you as it provides the Oregon Board of Licensed Professional Counselors and Therapists set of guidelines therapists must utilize in deciding whether child abuse is reportable for investigation:
OBLPCT Guidelines on Child Abuse
Note: To download Adobe Acrobat Reader for free, click here.
