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Forms to be completed by new clients are available below. Completed forms can either be emailed to me through this link or sent to me by regular mail at 92 Adams Street, Burlington, VT, 05401.
1. The Demographic and Insurance Information Form
2. Disclosure of Information
3. The Informed Consent Form
4. Use of Technology Disclosure and Limits of Confidentiality Form
5. The Authorization/Release Form (not to be used without your consent)
6. The Intake Form of personal and background information
7. The Signature(last) page of the Vermont Notice regarding Privacy of Your Health Information
8. Pages 3,4,&5 of The Telemental Health Authorization and Informed Consent Form
9. Title 26, Vermont Statute regarding psychologist conduct
The Disclosure of Information and Title 26 Vermont Statute need not be returned.
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