New Client Forms

Therapy in Chester and all of NJ

If you're a new client, please complete the following forms.  You may return completed forms via email. Please note that email is not a fully secure form of communication. By returning these forms electronically, you acknowledge and accept this risk.

• Client Psychotherapy Intake Form
• Parent Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy
• Credit Card Authorization

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

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