When initiating psychotherapy, there is a little paperwork. Included here are the forms for this clinic. These include forms that are required by law, one from our billing service, and one that explains the laws regarding HIPPA and Minnesota Laws and Rules about Psychology and Patient's Rights and Responsiiblities. There is also one form designed to obtain intake information, allowing for paperwork to be less a focus of the first appointment and to allow for more discussion to occur. At your intake, your therapist may also ask you to sign release of information forms for other family members or medical providers.
The following forms are here for you to download, print, and complete ahead of your first appointment. If you choose to fill these out prior to your appointment, please remember to bring them with you along with your insurance card.
* The Receipt of HIPAA Information form is to be signed acknowledging that you received and have read the HIPAA information along wtih the Rights and Responsibilities according to the Minnesota Board of Psychology.
* The Insurance Registration form asks for primary insurance information which you do not have to fill out if you bring your card along, and please note if you have secondary insurance. If you are not comfortable writing down your social security number, please feel free to wait or leave that space blank.
- Client Psychotherapy Intake Form
- Insurance Registration
- HIPAA Rights and Responsibilities
- Receipt of HIPAA Information
- Consent for Evaluation and Treatment
Your rights as you seek psychotherapy services are important to me. I want clients to be aware as they prepare for the first appointment that I take every legal and ethical decision in therapy seriously.
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