Book an Appointment
If you are excited to get started with therapy right now, fill out a counseling intake form so we can book your first appointment as soon as possible, then follow the steps below the form to complete the intake process. I will respond to your form within 24 hours. If you do not see an email from me, please check your spam folder.
Counseling Intake Form
These therapy intake questions cover more than just demographics. I ask you about what you want to work on in therapy, how you prefer to work, what qualities you're looking for in me as your therapist, and when you'd prefer to meet. I want to be the right fit for you, so the more you tell me about what you want from therapy, the better prepared I'll be to tell you whether I believe I can help you.
Let's be honest. Everyone's least favorite part of starting therapy is reading and filling out the intake documents. I get it, but it's necessary in order to deliver a high quality of care.
Please leave yourself a few days to read through and sign everything. Do not expect to start counseling the same day you first visit this site. You will need to sign an informed consent agreement before we schedule your first appointment, and to sign that agreement, you will need to read several documents and complete several forms.
I suggest completing the intake in the following order:
Read the description of services on my counseling page, the FAQs, and my about page.
Read my counseling policies and procedures.
Read my technology and security policies and procedures, which talks about the apps I use to provide psychotherapy online.
Read about my therapy services and fees, in which you will find information on plans, fees, appointment policies, and cancellation policies.
Read my notice of privacy practices which outlines HIPAA protections and will help you understand your rights.
Create your personal sign-in credentials for using teletherapy securely. You will need to either remember them or store them somewhere no one else can find them, and be able to retrieve them when needed. These credentials will include a user name and passwords, passcodes, and/or passphrases.
Password: A combination of letters, numbers, and symbols, generally 6-20 characters. The more characters and the more variety, the safer the password.
Passphrase: Typically a short sentence, such as “I like blue bikes.”
Passcode: Can be either a password or a passphrase.
Passwords, passphrases, and passcodes are case sensitive. You can find helpful tips on how to create safe passwords, passcodes, and passphrases in my HIPAA notice of privacy practices.
For my teletherapy practice, you will need three sign-in credentials:
A password for your Gmail account (the Gmail address is your user name). This gives you access to your therapy chart, private therapy and training materials, and the HIPAA-secure Google Chat app. You will not share this password with me and should not share it with anyone else.
An identity verification passcode (IVP) that you will set up during the intake process and provide to me at every session so I can confirm you are you. The IVP can be one word, a combination of words, or a short phrase. It should be easy for you to remember but not easy for someone who knows you to guess. You will also use this IVP to view encrypted emails. For details on how this works, see my technology and security policies and procedures.
A password for signing into the iPlum app which we will use for secure texts, phone calls, and faxes. More on that on in my technology and security policies and procedures and my tech trainings. You will not share this password with me and should not share it with anyone else. You can read more about how the app works in my technology and security policies and procedures. I have provided additional information to help you get acclimated to the iPlum app on my tech trainings page.
Complete the HIPAA-secure initial contact form and let me know 1) if you are interested in counseling services, and 2) if you have any questions about my counseling services. This form officially starts your intake process. I will respond via encrypted email once I have received your initial contact form. Please check your spam folder if you do not see an email from me within 24 hours. The encrypted email will have a ProtonMail address. You will be asked to enter your IVP to access the message. As discussed earlier on this page, you will establish an identity verification passcode (IVP) when you fill out your initial contact form. Your IVP will be the password for reading secure emails from me. Once you type in your password, the message will open up in a browser window. You will not need an app to receive and view these emails. For more information on ProtonMail, see my tech trainings page.
Complete the identity verification form. This form is not publicly available. You will receive it via encrypted email after I have received your initial contact form.
Complete the informed consent agreement. This form is not publicly available. You will receive the link to this agreement via HIPAA-secure email once you have sent the initial contact form and expressed an interest in counseling services. I will walk you through how to access a copy of your informed consent agreement during our first session. I do not schedule your first session until you have completed the informed consent agreement.
Respond to my encrypted email about scheduling our initial session, which will be anywhere from 60-120 minutes, so be sure to set aside two hours for your appointment. In that email, you will receive date and time options for our first session. You will also receive an email with an invitation to connect via our HIPAA-compliant text-messaging application. Note that you will not receive those emails until you have completed the steps above.
Once we have scheduled our initial session, head over to the payment page and select the initial session payment button. To hold the slot, payment is required no later than 24 hours prior to your scheduled appointment. The initial session fee is the same whether we meet for one hour or two. Please read my therapy services and fees policies and procedures to learn what is included in the initial session fee. When you pay for your initial session, you will be prompted to save your payment information in Square's secure payment system. Please be sure to familiarize yourself with my payment and cancellation policies on the therapy services and fees page.
Choose whether to complete the biopsychosocial history before our first session or during our first session. The purpose of the biopsychosocial history is to help me get a clear picture of where you're at, including what you've gone through up to now, what may have contributed to the circumstances that promoted you to seek therapy, and what problems you need to solve in your life. The more honest and thorough you are, the better equipped I will be to help you.
The form for this assessment is not publicly available. After I receive your initial contact form, I will email you the biopsychosocial form and you can decide then whether you would like to send it before our first session or complete it with me during our first session.
Advantages of completing it before the first session:
We can devote more of your first session to therapy.
Reading your responses in advance of our first session makes it possible for me to prepare suggestions for your treatment plan at that first session.
Advantages of completing it during the first session:
Completing the biopsychosocial history together gives us a chance to talk in depth about what has brought you to therapy.
Conversations that stem from the questions on the biopsychosocial history are an excellent opportunity for us to forge our therapeutic relationship.
If you would prefer to complete this history with me in our first session, please note that the session will likely take a longer. There will be no extra fee for the longer session time. I will need to set aside that extra time during our initial session, so please let me know in advance if this is how you'd like to proceed.
If you decide to complete the biopsychosocial history before our first session, please note that it will take 1-2 hours to complete, depending on the detail in your answers. Please send the completed form two days prior to your first session so I can review it thoroughly.
Complete the authorization/release of information form on my client forms page if you plan to have me communicate with anyone else about your treatment. If you wish for another service provider, a family member, or other support person to know of your presence in treatment, you will need to sign a release. If a friend or relative is paying for your treatment, you will need to sign a limited release (see FAQs). A release will not be necessary for your insurance company because I do not communicate with insurance companies on your behalf. I am a private pay provider, not an out-of-network provider, and I do not provide superbills.
Complete additional assessments if warranted. Based on the information you provide in your initial contact form, I may send you some additional online assessment forms to fill out for the initial evaluation process. The cost of these initial assessments is included in your initial session fee. If any fee-based assessments are warranted during the course of your treatment, I will always provide you with a good faith estimate of those costs prior to administering the assessments, and you will have the right to agree or decline.
Note that in this practice, you will need to complete the above intake process before scheduling an initial session. Once I've received your intake documents, I will send you an email with scheduling options. In that email, I will also provide a customized good faith estimate in keeping with the No Surprises Act. If you are not comfortable with this process, please seek immediate help from these resources.