New Client Forms
Should we choose to move forward after the consultation, you'll receive intake and policy documents to complete before your first session. Online signable versions are provided through the client portal after booking.
Standard intake & policy forms
Informed Consent for Psychotherapy
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Notice of Privacy Practices (HIPAA)
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Telehealth Consent
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Practice Policies
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Emergency Resources and Procedures
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Demographic & Clinical Intake Questionnaire
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Assignment of Benefits and Client Financial Responsibility
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
These documents are provided through the client portal after booking:
- Insurance Information (in-network clients)
Private-pay only
These documents apply only if you are paying out of pocket (not using in-network insurance billing).
Private Pay Agreement (self-pay clients only)
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Good Faith Estimate (No Surprises Act)
Download PDFPDF Viewer — tap Download PDF if the preview does not load on mobile.
Looking for crisis resources? See the Crisis Info page.
Questions about forms? Contact Rose through the consultation form.