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