Client Forms

Privacy Practices

These are for your convenience. You can choose to print and fill them out and bring them into your first appointment. I also have them for you to fill out in the office. If you choose to fill them out at the office please come 10-15 minutes early so that we can be ready use the time allotted for your session.  

The Notice of privacy is for your own use. No need to bring this form in. 

This form is consenting to my privacy practices and you have been informed of them. 

This form is for if/when you want me to be in contact with a personal medical professional. 

Client Intake 

The check-in form is each session. To keep track of the progress that has been made.

Personal Info and Consent for me to work with you.

Health History and on going concerns.

Covid-19 Policy

During this time and at anytime to help us all stay as healthy as possible I am doing all I can to keep my office clean and free from Covid. 

What I am doing...

  • cleaning and disinfecting between each client.
  • checking my temperature
  • wearing a mask during sessions 

What can you do....

  • before coming to your session check your temperature
  • wear a mask when coming into the office
  • if you feel sick or have been around someone that has covid just text or call and we can reschedule. 
  • remember to take care of yourself. You are important. 

"We work together to create lasting change."   Ashley Fitzgerald