In order to offer you the maximum amount of time during your session to discuss your concerns, I am including here some basic forms required by the clinical licensing board, to be filled out at your convenience. If you do not have access to a printer, I will have copies available at my office.
Audio/video recording is not a requirement to participate in ISTDP. However, if you will be an ISTDP client and consent to the use of audio/video recording, for the purpose of therapist effectiveness and ongoing supervision and training, the law requires your permission.
If you will be using insurance to cover your psychotherapy sessions, this form will allow me to work with the insurance company for you. I am also able to provide you a monthly statement which you can use to directly bill your insurance company yourself. If you intend to pay by credit card, you will need a Paypal account to use my website payment portal.
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), your signature on this form allows me to acknowledge that you are a client and to authorize release of, or obtain information about you.
Note: To download Adobe Acrobat Reader for free, click here.