Forms for your Initial Appointment

If you're a new client, please print out the following three (3) forms, complete them, and bring them with you to your initial appointment. You may also mail them in advance of your appointment to the office at 316 East Mitchell Street, Petoskey MI 49770. Another option is to fax them to the office at 231.622.8548 .

You will find that the intake form is quite comprehensive, thus permiting me to efficiently and thoughtfully obtain a congruent picture of you and your background in a way that facilitates the assessment process. Please allot at least a total of 45 minutes to complete all 3 forms.

If you would like me to coordinate care with another provider (for example, your primary care physician), complete this form to authorize release of confidential information:

  • Authorization to Release Protected Health Information (PHI) Form
  • HIPAA forms for my office are available to you at our appointment. If you would like to have a copy of them in addition to the Confidentiality and Insurance forms above, you may opt to read them here.

    • HIPAA Michigan PSY-PT Agreement

    Note: To download Adobe Acrobat Reader for free, click here .

    Helpful Forms

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