Forms

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

• Insurance and Billing Pre-authorization Registration Form
• Credit Card or Check Authorization Form
• Client/Patient Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy
• Marital Counseling Initial Intake Form
• Guidelines and Agreements for Couples Counseling
• Child/Adolescent Psychosocial Assessment

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
• Informed Informed Consent Telehealth for Skype-Phone-Email Sessions Insightforwellness.com
• CBD Waiver

For Preoperative Evaluations Please Use The Following Forms:

Preoperative Psychological Evaluation Questionnaire Form - Click Here to Fill Out
HIPAA Authorization to Disclose Information From
Credit Card or Check Authorization Form

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