Welcome to my practice! My goal is to help you feel better as soon as we can. So, in order to help us move from an assessment phase to the treatment phase faster, I need written information from you. Please help me with this by following these 4 steps. Please allow at least 30 minutes.
Step 1: Fill out my new client forms:
- Information about Psychotherapy (pages 1-3) orients you to my practice and payment policies, what therapy is all about, the risks and benefits of psychotherapy, and confidentiality issues. You can review this online and need not print it out. It is important legally and ethically for you to be informed about these issues before we start therapy. Please ask me any questions you still have during any of our sessions. Doing this online helps us streamline the therapy process.
- HIPAA Notice of Privacy Practices (pages 4-6) informs you about your privacy rights as required by federal law. Again, you can review this online and need not print it out. Please carefully review this form. It provides important information about legal limits to your confidentiality as a psychotherapy client.
- Signature Page (page 7) acknowledges your understanding of the orientation information. Please print this out, sign it and bring it in with you.
- Intake Form (pages 8-14) provides me some general information about you and helps me zero in on your concerns more rapidly during your first session, allowing us to start addressing your issues sooner. Please print these out and bring them to your first session.
Step 2: Please fill out any of these questionnaires that might apply to you. Please be aware that no short questionnaire can provide an accurate diagnosis. This can only be done by an appropriately trained mental health professional.
- Attention-Deficit Hyperactivity Disorder: Three questionnaires, one on ADHD, one on sleep and one on functioning problems.
- Anxiety: Two questionnaires, SAS and ASI
Step 3: Please fill out the Credit Card Form if:
- You would like to pay your fee or copay by credit or debit card.
- You have an unpaid deductible for this year
- You have an out-of-state Blue Cross Blue Shield policy.
- You have an insurance policy that is not Blue Cross Blue Shield or Medicare.
Step 4: Please fill out the Release of Information Form if:
- You have seen another psychotherapist in the last 2 years
- You have gotten any psychotropic medications in the last 2 years or you are getting them now.
- You want a referral for psychotropic medications (leave the first part blank, and after I give you a referral, we can fill that part out)
- You have ever been in the hospital for any mental or emotional condition
- You would like me to send your primary care physician a very brief summary of your diagnosis and treatment (some clients like their physician to be fully informed about all the health care they are getting, others prefer to keep this information more private).
Here is information on parking. I’m looking forward to meeting you in person.
Jan Willer, Ph.D.