Please complete the Intake Forms prior to your first session with your therapist. You can email the completed forms to us at:  Please download and review the HIPAA Notice, Department of Health publication, and your selected clinician’s disclosure statement prior to your first appointment. To access these forms, please click on the links below.  In order to read these forms, you must have Microsoft Word installed on your computer.

Intake Forms

HIPAA Notice of Privacy Practices

Department of Health publication, Counseling or Hypnotherapy Clients

Release of Information Form (only if requested by your clinician, or for treatment of minor children over 13, for billing and scheduling purposes)

Lara’s Disclosure Statement

Consent for Energy Psychology (for Lara’s clients)

Carmen’s Disclosure Statement

Lydia’s Disclosure Statement

Anne McKenzie Disclosure Statement

Patricia’s Disclosure Statement

Eva’s Disclosure Statement 

Victoria’s Disclosure Statement (request from intake; forthcoming on website)