Please identify which packet you will need. Complete and email paperwork to me.
- If printed and filled out by hand, please take a photo of required documents or use Adobe Scan (free app for phones) and send them to me via email.
- If using a PDF writer such as Adobe Reader, Adobe Fill and Sign (phone app), Preview (Mac) please save and attach this document and the associated APA Assessment through email.
Disclosure Statement - Maryland
Required for all clients located in MD to read and understand. It is referenced on the signature page. This does not need to be printed unless you want one for your records.
Disclosure Statement - Kansas & Utah
Required for all clients in KS and UT to read and understand. It is referenced on the signature page. This does not need to be printed unless you want one for your records.
Release/Exchange of Information
This form is necessary if you would like me to/or believe it would be helpful for me to speak with other practitioners (therapists, physicians, teachers, case managers, etc.) and exchange information about the services you are receiving.
Additional Intake Paperwork Packets