Please save the forms to your computer and open them with Adobe Acrobat. You then fill these out on your computer, save them as PDF file and email to [email protected].
All clients will need to read and sign the Psychotherapist Patient Services Agreement , and Electronic Communication Policy.
Adult Clients : Complete Personal History Form-Adult
Clients under 18 : Compolete Personal History Form-Child
Very Important: Complete Forms Completely. Do not leave blanks. You may write "none" or "not applicable" to indicate your answer.
Only Complete the following if you would like information to be shared with your primary care doctor or psychiatrist.