Forms

For present and prospective clients

Information forms

The Intake Information forms are available here in two formats – the first (MS Word DOC format) may be filled out in your word processor, and the second (PDF) may be printed and filled out by hand. Depending upon how your browser is set up, a file may download directly to your hard drive OR may open automatically inside your browser. If it opens in your browser, save the file using the save function of the program in which it opens. You can then go to the directory where it’s saved and click on it to open it.

Client Intake Information form

I prefer you to fill this out in advance, when possible, so that I may be
better prepared to help you when we first meet. 

• Client Intake Information form – This is a Microsoft Word “DOC” file which may be opened by most word processor programs. Once open, you can type into it the information requested, and then send it to me as an email attachment.
• Client Intake Information form – This “PDF” format version of the file requires the Adobe Acrobat Reader which is installed on most computers (you can print the form from this program).

Family Tree Data form

This form, which I use to develop a picture of a client’s developmental history, can be filled out either before we start or shortly afterwards. It doesn’t take long, and significantly speeds up the assessment process. 

• Family Tree Data form – This is a Microsoft Word “DOC” file which may be opened by most word processor programs. Once open, you can type into it the information requested, and then send it to me as an email attachment.
• Family Tree Data form – This “PDF” format version of the file requires the Adobe Acrobat Reader which is installed on most computers (you can print the form from this program).

Legal forms

• Informed Consent for Disclosure of Mental Health Records and Information - This “PDF” format version of the file requires the Adobe Acrobat Reader which is installed on most computers. This form must be printed and signed, with a witness (you can print form from this program) – see Note.

Note

Most computers have the Adobe Acrobat PDF reader already installed. It you do not have this program, or need to upgrade yours, visit the Adobe download page.