Learn From Yesterday

Live For Today         Hope For Tomorrow....~Albert Einstein
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Therapy Forms and Symptom Assessment


Intake Form and Policies:
If you are a new client, please complete the following forms and bring them to your first therapy session, the intake form is completely confidential:

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
 

Helpful Tools to Assess your Symptoms:
Screening Tools from The Anxiety & Depression Association (ADAA) and The Mental Health Association (MHA), these sites can also provide a lot of information on mental health issues.
 

ADAA Anxiety, PTSD, Depression, OCD, Phobia Screens

 
Alcohol / Substance Abuse Self Test here

Aces too high?
This is the "Adverse Childhood Experience Scale" (ACES) - Therapy can definitely help with the issues that are raised on this questionnaire:

ACE Questionnaire


 
 
verified by Psychology Today
 
 
 
 
 

Helpful Forms

Click here to view and print forms for your appointment.

Click Here