Forms/Portal

Client Portal

Here you can schedule, cancel, or request a change to your appointment.

This is where you will log in for telehealth/virtual appointments.

Here is where you will access your initial paperwork to complete before our first appointment.

Don’t worry! It is HIPAA protected, confidential, secure.

Here is the paperwork that should be completed at least 24 hours PRIOR to your intake appointment.

I know it is a lot of paperwork and I understand that it can be overwhelming. Your health and safety is very important, and I need to collect a lot of information to get the full picture of what is going on with you clinically. Having some of the basic information collected, insurance and billing information entered, and forms signed, allows more time to get to know each other at your first visit. Please let me know if you have any questions or concerns about completing paperwork.

Client Contacts Form—Contact information for your emergency contacts, family, physician

Client Information Form—Your basic demographic information, address, phone, etc.

Client Insurance Form—If you do not have insurance or you are choosing not to use your insurance, you will need to click the box to opt out. If you are using insurance, you will enter all of your policy information here. *Signature required*

Payment Authorization—This is where credit card information is entered into my secure system. Once entered, I only see the last 4 digits of your card. I require a card to be kept on file. *Signature required*

Consent for Services—This form explains the risks and benefits of treatment, policies, fees, and you will sign to consent to be treated. *Signature required*

Notice of Privacy Practices—HIPAA information that you need to review and sign. *Signature required*

Client History Form—Details of why you are coming in for therapy. You will need to complete this and send it back.

GAD-7—This is an assessment form to measure anxiety

PHQ-9—This is an assessment form to measure depression

ROI (Release of Information)—This is an optional form allowing me to share information of your choosing with another person or provider, typically your family physician or psychiatrist/nurse practitioner. *Signature required* See notes below

How to sign ROI form online (optional):

Click on the document and select “view”

Click the button at the top of the screen with an arrow pointing up, and then select “markup”

Then click on the pen and sign your name and write in initials. Also note the undo button if you make a mistake.

You should be able to save and upload it back to the portal. Please let me know if you have any issues.