Forms

Forms for New Clients

Please bring to your first appointment:

For Stanford students who will be using CardinalCare/MHN insurance:

For ValueOptions insurance members:

Additional Forms

  • Authorization to release information: I am unable to discuss information about you without your written authorization, except for situations described in the HIPAA notice. This is the form we would use if you and I both agree that it would be useful for me to communicate with other people involved in your care, such as your primary care physician, your psychiatrist, or a former therapist.
  • Questionnaires  At times I may ask you to fill out these questionnaires.