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Blue Mountains
Blue Mountains

Helpful Forms

If you are a new or returning client, please complete the following forms and bring them to your first therapy session.

  •  Intake Form-  Please fill out the appropriate form ie. Adult, Adolescent, Couples or Child Intake Form.
  • Insurance Form    This forms can be emailed ([email protected]) or faxed (907-247-5001) before your therapy session, so that I can inform you of any out of pocket expenses.

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

  • Authorization to Disclose Information Form

 

 
Couples Enrollment
 
 
Insurance Form
 
 
Adult Intake Form
 
 
 
 
Child Intake Form
 
 
Authorization to Disclose Information Form
 

 

 

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

 

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Helpful Forms

Click here to view and print forms for your appointment.

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