Client forms
All forms are available below in pdf format from Adobe Acrobat Reader. Click here to install Adobe.
Intake Assessment Form
Please complete this form prior to your first session. It informs Katie about you, your history and your counseling goals and needs.
HIPAA Notice of Privacy
Review and complete this document prior to your first session. It contains information on how your private medical information is used and accessed.
Agreement for Services
Review and complete this document prior to your first session. It contains information on services, fees and privacy details. Virtual sessions are carried out via Spruce.
Agreement for Services & Informed Consent
Email/Text Informed Consent
Please review and complete this document covering sensitivity of email and SMS/text communication prior to your first session.
Email & Text (SMS) Messaging Informed Consent
Electronic Payment Authorization
Download and complete this form if you intend to pay for session fees via credit card.
Release of Information
If you would like Katie to speak with anyone (e.g., primary care physician, psychiatrist, etc) regarding your treatment, complete this document and bring to your first session.
Good Faith Estimate
Health care providers are required to provide a Good Faith Estimate for current and prospective clients who are private pay or uninsured.
COVID-19 Public Health Crisis Consent Form
This document contains important information about our decision (yours and mine) to resume in-person services in light of the COVID-19 public health crisis.
COVID-19 Informed Consent