New Client Forms
Welcome to my practice! At the present time, I am accepting new clients for adult ADHD assessments only. My goal is to assess you as carefully and thoroughly as possible. Please help me by following these 4 steps. Please allow at least 30 minutes. I will send you a link for a confidential dropbox that you can use to submit your forms before your first appointment. Please note that I need these forms at least 24 hours in advance of your appointment time.
1
Fill out my new client form [PDF, Word Doc, Apple Pages]. There is a lot of information about mental health treatment and then some forms to fill out. Please review this carefully. Please upload the new client form in either Word or pdf format.
2
Fill out the Informed Consent Addendum for Phone or Video Chat Sessions form [PDF, Word Doc, Apple Pages]
3
Fill out all three of these ADHD questionnaires.
4
If you have a significant history of depression or anxiety, please fill these out:
- Depression
- Anxiety: Two questionnaires, SAS and ASI
5
Fill out the Credit Card Form [PDF, Word Doc, Apple Pages]. You will be given an option to pay by Zelle or Venmo later if you prefer.
6
Upload copies of the front and back your insurance card. Photos are fine.
7
This step applies to you only if you are paying out of pocket or you are uninsured--not if you have Blue Cross PPO or Medicare. You have rights under the No Surprises Act--access these rights here to review them. If you are coming for an assessment of ADHD, here is your Good Faith Estimate for your review.
8
Fill out the Release of Information Form for your psychotherapist and your prescriber (if you have them).
9
Upload all of the documents into your confidential dropbox. You should have at least 7 different documents. Word, pdf or photos are ok. Please do not upload documents in pages format.