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
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
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