Helpful Forms


If you're a first-time client, please review and complete the following forms, bring them to your first session.

  • Informed Consent Form
  • Client Intake Form
  • Privacy of Information Form
  • Midwest EAP Intake Form (for clients referred by Midwest EAP)

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

  • Consent to Release Information Form

 


Informed Consent Form


Client Intake Form


Privacy of Information Form (HIPAA)


Consent to Release Information Form


Midwest EAP Client Intake Form


Client Agreement Form


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