New client information
forms
- Counselor Disclosure Form
- Credit Card Pre-Authorization Form
- Notice of Privacy Practices
- Individual Therapist Agreement
- Release of Information
- Award of Scholarship/Financial Agreement
What to expect
Once you schedule an appointment, your contact information will be entered into the SimplePractice system. Within 24 hours of that time you should receive an email containing a link to the online Client Portal along with a designated username and password. After you sign in, you will be prompted to change your password to something easier for you to remember. The Client Portal is an easy to use system for storing and accessing your information. You will be able to update your contact information, enter and store your credit card information for payments, as well as access and sign any necessary forms prior to our first appointment. This is immensely helpful so our first appointment can be focused on getting to know each other, though if you would like we can go over the forms during our session.
policies & procedures
What follows is a section of a document regarding your privacy and your rights as a patient. For the full PDF document, please see the Notice of Privacy Practices above.
Website Privacy
Any personal information you provide me with via my website, including your e-mail address, will never be sold or rented to any third party without your express permission. If you provide me with any personal or contact information in order to receive anything from me, I may collect and store that personal data. I do not automatically collect your personal e-mail address simply because you visit my site. In some instances, I may partner with a third party to provide services such as newsletters, surveys to improve my services, health or company updates, and in such case, I may need to provide your contact information to said third parties. This information, however, will only be provided to these third-party partners specifically for these communications, and the third party will not use your information for any other reason. While I may track the volume of visitors on specific pages of my website and download information from specific pages, these numbers are only used in aggregate and without any personal information. This demographic information may be shared with my partners, but it is not linked to any personal information that can identify you or any visitor to our site.
My site may contain links to other outside websites. I cannot take responsibility for the privacy policies or practices of these sites and I encourage you to check the privacy practices of all internet sites you visit. While I make every effort to ensure that all the information provided on my website is correct and accurate, I make no warranty, express or implied, as to the accuracy, completeness or timeliness, of the information available on my site. I am not liable to anyone for any loss, claim or damages caused in whole or in part, by any of the information provided on my site. By using my website, you consent to the collection and use of personal information as detailed herein. Any changes to this Privacy Policy will be made public on this site so you will know what information I collect and how I use it.