Forms for New Clients
Credit Card Form
Notice of Privacy Practices/ HIPPA: (read-only - no signature required)
Consent to Teletherapy: Please submit this form to me prior to our first video/audio session.
Identifying your Out of Network Benefits: Use this form when calling your health insurance provider to ask about your mental health benefits.
Tools and Handouts for Clients
Therapy Progress Check-in: It’s helpful for you and your therapist to periodically set aside time to discuss how therapy is going for you. Here are some questions to consider.
Depressions Symptoms Checklist: You and those closest to you can use this form to monitor your depressive symptoms. Learn about your unique ways of experiencing depression, monitor changes and progress, and watch for red flags that indicate a worsening of symptoms or crisis.
Activity Schedule: Depression often leads to, and is worsened by, a reduction in activity levels and a withdrawal from the world. In order to recover, it is critical to engage with the world, to be active, and to handle your responsibilities. Use this form to commit yourself to specific daily goals.
Unhelpful Thinking Styles (aka "Cognitive Distortions"): This list describes some ways of thinking about the self, the world, and others that distorts reality and feeds bad moods.
Challenging Unhelpful Thoughts: (aka the "Thought Record") Use this form for tracking your thoughts and related behaviors which contribute to unwanted feelings of sadness, hopelessness, pessimism, anxiety, panic, anger, etc. Practice challenging those thoughts and choosing more helpful, balanced self-talk that will leave you feeling better and prevent a negative downward spiral.
I-messages: This is a simple but very important tool for non-defensively communicating your needs and feelings to your spouse/family members.
Fair Fighting Rules: Develop skills for more loving and effective, less stressful problem resolution in all your relationships.
Chart of Quit Smoking Medications: Learn about and compare the medications available to help smokers through the initial withdrawal phase.
IBS severity Index: Track you IBS symptoms over time.