top of page

Keri Cohen_Murky Green.jpg

CLIENT FORMS

New Client Forms

Click to download. Please complete and bring to your first appointment.

Adult Intake Questionnaire

Child Intake Questionnaire

Agreement to Pay for Professional Services

Consent to Treatment

Consent to Use and Disclose Your Health Information

Notice of Privacy Practices - Brief Version

Notice of Privacy Practices - Long Version

Additional Forms

Click to download. Please complete and bring to your next appointment.

Release of Information

Teletherapy Consent Form

Good Faith Estimate (Private Pay Clients)

bottom of page