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

Limits of Confidentiality/Cancellation

Consent for Treatment

Patients’ Rights and Responsibilities

Notice of Privacy Practices 

Doctor Referral

Consent to Release Information

Professional Disclosure Statement

 

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.

 

“There are no facts, only interpretations.”  Friedrich Nietzsche

© 2016  Carrie Mitchell Counseling

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