Healthcare Forms

Health Care Forms: to be filled out prior to your appointment

To fill out on line: Click on the download button of the appropriate form below. An interactive form will be downloaded to your computer. Fill this out, save and email to us prior to your appointment. If you do not have a digital signature, just send it unsigned and sign it at the time of your appointment. (see more details below)

To fill out by hand: If you prefer, you can download it to your desktop, print it out on your home printer, and fill it out by hand. You can email, mail, or bring it with you to your appointment.

Please choose and download the appropriate form below:

New Patient  Intake Packet

If you are a new patient, please download this form on your computer by clicking on the “download” button below.

Email it to us at: [email protected] or Fax  to us at 941-952-9705 

• Registration Form

Child Intake Forms

If you filling this out for your child, please download the registration and the consent form on your computer by clicking on the “download” button below.

Email it to us at: [email protected] or Fax  to us at 941-952-9705 

• Child Registration Form
• Minor Consent Authorization Form

Forensic Intake Forms

If you filling this out for your child, please download this form on your computer by clicking on the “download” button below.

Email it to us at: [email protected] or Fax  to us at 941-952-9705 

• Forensic Registration Form

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.