Client Forms

Practice Forms
Below are client forms available for you to downloaded, carefully review, fill out and sign. New clients should return these to me prior to our initial meeting.

The Informed Consent provides information about my practice, the legal and ethical aspects of this work and our relationship, and telehealth information. It also includes a section about your insurance carrier and coverage.

The HIPAA form includes information about your privacy of information.

Please read both of these forms carefully, sign the Informed Consent, and return it to me prior to our first meeting.  These are Adobe PDFs that you can download to your computer and then open directly in Adobe so that you can complete them on your computer. It is fine for you to just type your names into the form to acknowledge your agreement with them. Please email the signed forms to me at or Fax it to me at 802-488-5714.

The Good Faith Estimate provides a template of estimated costs for psychotherapy services. This will completed and signed for all services provided to clients paying out-of-pocket for these services.

If you have any questions, please contact me.

Informed Consent


Good Faith Estimate