Helpful Forms

If you're a new client, please complete the following forms and bring
them to your first therapy session.

• Psychotherapy Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy
• Insurance Pre-Authorization Form

Psychotherapy Intake Form

Limits of Confidentiality/Therapy Cancellation Policy

Insurance Pre-Authorization Form

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:

• Authorization to Disclose Information Form

Authorization to Disclose Information Form

• Minnesota Board of Marriage and Family Therapy - Client Bill of Rights

MN Board of MFT - Client Bill of Rights

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