Client Forms

The 5 (five) forms listed below are important for you to download, read, and sign before we meet. Please bring Forms 1, 2, 3, and 5 to our first appointment together.
Thank you.

1.  New Client Information and Intake Form (pdf)
2.  Agreement Regarding Communications with Clients (pdf)
3.  Treatment and Fee Agreement (pdf)
4.  Massachusetts Privacy Disclosure (Please Read) (pdf)
5.  HIPAA Privacy Disclosure Signed Acknowledgement (pdf)

I am an Out-of-Network Licensed Ph.D. Psychologist for most insurance plans. While I do not participate directly in insurance plans other than Blue Cross/Blue Shield, I will be pleased to provide all necessary paperwork so you can submit a receipt for partial reimbursement from your carrier. This means that payment for services is due after each session. Please check your specific plan to determine whether it will reimburse you, and at what rate. This varies by plans. I advise all clients to call their insurance company before we meet for our first session.