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Blue Mountains
Blue Mountains

Helpful Forms



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

  • Client Intake Form
  • Information, Disclosure, and Consent 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 For Use or Disclosure of Protected Health Information Form

If you would like to inquire of behavioral health insurance benefits please use the following form when talking with your insurance company:
  • Mental/Behavioral Health Insurance Benefits Verification Form

Client Intake Form  
Information, Disclosure, And Consent Form  
Confidentiality/HIPAA Practices Form

Authorization For Use/Disclosure of Protected Health Information Form  
Mental/Behavioral Health Insurance Benefits Verification Form  
   

Note: To download Adobe Acrobat Reader for free, click here.


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Helpful Forms

Click here to view and print forms for your appointment.

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