Forms

Before therapy begins, certain paperwork must be completed — an ethical and legal requirement. You can complete it here, ahead of your first session. Everything you enter is encrypted end-to-end; only we can read what you write.

We also have links to printable versions of each form, for your records, or if you prefer to mail your forms to us.

Before Our Free Half-Hour Consultation

• Intake

The Intake Form asks for your most thoughtful responses about you and your life. We require this form before scheduling the consultation. Each person attending therapy completes their own form, privately. For a printable version, click here.

• Notice of Privacy Practices

The Notice of Privacy Practices is required by state and federal law; it describes how information about you may be used and disclosed. There is nothing to fill out, but each person's signature is required before the consultation. For a printable version, click here.

• Insurance Information

If you plan to use your health insurance, please also complete the Insurance Information Form before your first session, or even before our free half-hour consultation if you would like to verify coverage as part of decision-making. The form gives us what we need to verify your benefits and bill your plan — including photos of your insurance card, which you can take with your phone. If your coverage changes later — a new card, a new job, a new plan — this same form is how to send us the update. When we hear from your insurance company about your coverage, we will let you know what they tell us.

Required Before Our First Session

• Informed Consent for Psychotherapy

The Informed Consent for Psychotherapy defines how our professional relationship begins, including the limits of confidentiality. Please read it carefully, and raise any questions or concerns with us before signing. For a printable version, click here.

For Therapy From a Distance Only

• Informed Consent for Telemedicine

We meet in our office; the Informed Consent for Telemedicine is for those rare occasions — a temporary illness, a brief absence from town — when we may meet by telemedicine instead, assuming all parties are in the state of Wisconsin. This form adds to the standard Informed Consent the matters particular to meeting at a distance. It's needed only if we arrange such a session. For a printable version, click here.

For EMDR Only

• Informed Consent for EMDR

The Informed Consent for EMDR is completed together in the office when EMDR becomes part of our work; there's nothing to submit online. A copy is available here for your records. For more about EMDR itself, see our EMDR page.