If you have scheduled an initial appointment, please download, read, print and fill out/sign the following forms as indicated, and bring them with you to the initial visit, or make arrangements to send them to me via secure email:
1. For individual, couples/relationship or family therapy: New Client Background Information Form & Office Policies
Sheet, and Patient Health Questionnaire
Therapy Intake Forms
Patient Health Questionnaire
For group therapy: New Group Member Background Information Form and Office Policies Sheet:
IFS Group Therapy Forms
Crone Group Therapy Forms
2. For ALL new clients:
HIPAA paperwork: The Health Insurance Portability and Accountability Act (HIPAA) requires that health care providers notify patients of their policies affecting confidential patient/client information.
Please download a copy of my HIPAA notice for your records:
HIPAA Notice
Please print out and sign the Informed Consent form and bring it to your first session:
HIPAA Informed Consent
-For more information about HIPAA, see http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html
If you'll be meeting with me virtually/online, please sign the Telehealth Informed Consent form and send me the
signature page only:
Telehealth Informed Consent form
3. If you will be using insurance:
If you have an insurance plan OTHER than the Duke University student plan, excepting Medicare, use these questions to
call your insurance company and ask about your plan's "out-of-network outpatient mental health benefits:"
(Medicare excluded)
Insurance Benefit Information
And for ALL insurance plans, except for Medicare-- the Duke student plan, and also those of you
who are using out-of-network benefits and would like me to file the claims (if you prefer to do the filing yourself,
please ignore this):
New Client Insurance Policy Information
Sheet, and Patient Health Questionnaire
Therapy Intake Forms
Patient Health Questionnaire
For group therapy: New Group Member Background Information Form and Office Policies Sheet:
IFS Group Therapy Forms
Crone Group Therapy Forms
2. For ALL new clients:
HIPAA paperwork: The Health Insurance Portability and Accountability Act (HIPAA) requires that health care providers notify patients of their policies affecting confidential patient/client information.
Please download a copy of my HIPAA notice for your records:
HIPAA Notice
Please print out and sign the Informed Consent form and bring it to your first session:
HIPAA Informed Consent
-For more information about HIPAA, see http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html
If you'll be meeting with me virtually/online, please sign the Telehealth Informed Consent form and send me the
signature page only:
Telehealth Informed Consent form
3. If you will be using insurance:
If you have an insurance plan OTHER than the Duke University student plan, excepting Medicare, use these questions to
call your insurance company and ask about your plan's "out-of-network outpatient mental health benefits:"
(Medicare excluded)
Insurance Benefit Information
And for ALL insurance plans, except for Medicare-- the Duke student plan, and also those of you
who are using out-of-network benefits and would like me to file the claims (if you prefer to do the filing yourself,
please ignore this):
New Client Insurance Policy Information