New Client Forms
After scheduling your consultation, you'll receive intake and policy documents to complete before your first session. You can preview the documents below; online signable versions are also provided through the client portal after booking.
Standard intake & policy forms
Informed Consent for Psychotherapy
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Notice of Privacy Practices (HIPAA)
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Telehealth Consent
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Practice Policies
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Emergency Resources and Procedures
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Demographic & Clinical Intake Questionnaire
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Good Faith Estimate (No Surprises Act)
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Assignment of Benefits and Client Financial Responsibility
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These documents are provided through the client portal after booking:
- Insurance Information (in-network clients)
- Records Request Form
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)
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Looking for crisis resources? See the Crisis Info page.
Questions about forms? Contact Rose through the consultation form.
— No commitment