Call to Schedule an Appointment 888-988-3008
Providing Online Therapy for All Residing in the State of Florida
Intake Documents
Secure and HIPPA Compliant
As a therapist who focuses on the whole person, I require specific documents be completed prior to your initial appointment with me. If you are considering seeking therapeutic care with me the below documents are required to start the process.
Intake Forms
The More I Know, The Better I Can Assist
Each of the below intake forms are required prior to your initial appointment. The first step in the therapeutic process with me involves paperwork.
As a trauma professional and therapist who believes in focusing on the whole person, my intake forms provides and gives detailed information to assist me with providing you with the best possible care. You will be sent a secure email that will require you to setup a password to access and complete the below attached forms.
Patient Intake Form
Patient History Questionnare
Notice of Privacy Practices
Counseling Contract
Understanding the Initial Process
The initial process is simple but requires your review and signature on a few of documents. Once you complete and return the four documents above, and scheduled your initial appointment with me you will be sent an invite to my client portal. You will need to set-up the client portal as part of your access to me. Initially when you setup the client portal you will have some additional documents awaiting your review and signature. Below are the forms you will need to complete:
Credit Card Consent - Each client is required to provide a valid credit card on file. This forms acknowledges that you give consent to charge your card for co-payment/deductibles or out-pocket payments for private pay clients and/or late cancellation or no shows on scheduled appointments.
Email/Text Consent - This forms provide consent to receive emails/text for reminders of scheduled appointments
Telehealth Consent - The Telehealth consent acknowledges that you give consent to provide care via a secure HIPPA compliant video system Doxy.me
Attendance and Your Responsibility as a Client - This forms requires your review and signature acknowledging that you have read and received a copy of my attendance and patient responsibility information.
Practice Policies and Procedures - The form provides detailed information on my practice policies and procedures so that you can be fully informed on the procedures while in therapy with me and after.
GAD-7 Scale - This is an assessment to help me better understand if you are struggling with anxiety so that I can assist you in that area.
PHQ-9 Questionnaire - This is also an assessment to help me identify if you are struggling with depressive symptoms. If you are paying with insurance, this will also assist with your diagnosis. As a private pay client it is only for making me aware so that I can also assist in this area.
© Copyright. All rights reserved.
We need your consent to load the translations
We use a third-party service to translate the website content that may collect data about your activity. Please review the details in the privacy policy and accept the service to view the translations.