916-936-3960

1200 28th Street
#301
Boulder, CO 80303

Forms

Please download, print, read, and sign these forms prior to our first session so that we do not have to use our meeting time to cover them in their entirety. Once signed, you will need to upload a digital copy of them and save them to the computer you will be using for our online therapy appointment. You will be able to return them to me electronically from that computer during that session. I will give you a chance to ask questions about them before you return them to me, so you feel aware of what the informed consent and intake process entails.

These forms are grouped into two categories: items to read and items to sign/complete. Please take your time with the items to be read first, make sure that you understand them, and then sign that consent on the forms to be signed. You only need to return to me the forms that need to be signed. This is also a heads up that the “Client Information Form” may take you up to half an hour to complete.

Forms to read:

Office Policies and Therapy Contract

Online Therapy Informed Consent Form

Electronic Records and Billing Disclosure

Notice of Privacy Practices

CA Proof of Licensure

Forms to sign:

Client Information Form

Acknowledgement of Notifications and Agreement to Policies

Nonsecure Communications Consent From