Forms for your 1st session

HIPAA Services & Financial Policies
Please fill out this form that includes information about our mental health services and financial policies.
HIPAA_Service_Privacy_Financial_Policy.d
Adobe Acrobat Document 141.1 KB
Payment Contract Form
Please fill out this form for either insurance or sliding scale payments.
HIPPA PAYMENT CONTRACT FOR SERVICES.pdf
Adobe Acrobat Document 166.9 KB
Your Rights & Responsibilities
Rights and Consent to Treatment.pdf
Adobe Acrobat Document 729.1 KB

Additional Forms

Yoga Liability Waiver
Please fill out this form if you'd like to receive yoga instruction in addition or apart from mental health services.
Yoga Liability Waiver.pdf
Adobe Acrobat Document 616.9 KB
Release of Confidential Information Form
Please fill out this form if you wish to have any session information shared with another health provider, program, or facility.
Release of Information.docx.pdf
Adobe Acrobat Document 88.8 KB
Gender Affirming Therapy Referral Letter Form
Please fill out this form if you want to be seen, for at least two sessions, to receive a secondary referral letter for gender affirming surgery/treatment. (Note, not all gender affirming therapies need two referral letters.)
GAS Referral Letter.pdf
Adobe Acrobat Document 96.4 KB