Patient Forms

New Patient Forms

Below you will find the new patient forms.  There is one for children and adolescents (under 18) and one for adults (over 18). The appropriate form should be completed after we have decided that we are a good fit for each other. They are all electronic, but you have the option to print them as well if you prefer.  At the end of the form, you will find my consent forms to electronically sign.  If you print the new patient questionnaire packet, please send the completed forms as an attachment in Elation Passport (my HIPAA-compliant patient portal) so that you can secure an evaluation appointment.  New patient forms are sent to me securely and through HIPAA-compliant software once completed electronically online.  This form must be done in order to confirm an appointment. 

New Child/Adolescent Form: https://intakeq.com/new/gE6XbI

New Adult Patient Form: https://intakeq.com/new/slJHZ9

Release of Information

This form is for new and current patients who would like for me to communicate with other physicians and members of the treatment team (psychologists, school, etc.).  One form must be done for each entity.  You may submit multiple forms if you have multiple treatment team members.

Release Form: https://intakeq.com/c/5b6e424b2604a727ec3c5941