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.
1. For individual, couples/relationship or family therapy: New Client Background Information Form and Office Policies
Sheet:
Therapy Intake Forms
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 our 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
Due to COVID-19, clients must be fully vaccinated, including boosters, in order to meet with me in person. Otherwise,
sessions are currently conducted via telehealth (video or telephone).
If you'll be meeting with me online, please sign the Telemental Health Informed Consent form and send me the
signature page:
Telehealth Informed Consent form
Sheet:
Therapy Intake Forms
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 our 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
Due to COVID-19, clients must be fully vaccinated, including boosters, in order to meet with me in person. Otherwise,
sessions are currently conducted via telehealth (video or telephone).
If you'll be meeting with me online, please sign the Telemental Health Informed Consent form and send me the
signature page:
Telehealth Informed Consent form
3. If you will be using insurance:
If you have an insurance plan OTHER than the Duke University student plan, use these questions to call your insurance company and ask about your plan's "out-of-network outpatient mental health benefits:"
Insurance Benefit Information
And for all insurance plans-- the Duke student plan, and 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
If you have an insurance plan OTHER than the Duke University student plan, use these questions to call your insurance company and ask about your plan's "out-of-network outpatient mental health benefits:"
Insurance Benefit Information
And for all insurance plans-- the Duke student plan, and 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