Forms
Below are the forms necessary to turn in prior to starting therapy. The Release of Information (ROI) is not a required form.
You may also sign these forms electronically (electronic signature page on this website) if you do not wish to download, sign, scan and/or send a picture of these forms back to me. Reminder: electronic media is not perfectly safe and even with my encryption and passwords, data breaches can happen.
If you do wish to scan them back to me, do so at:
[email protected]
*New* Informed Consent
Informed Consent
Click on the picture above to access the form.
This is a REQUIRED FORM!
Please read all content and ask questions prior to signing, signing indicates you have read and understand the information.
Specifically, fill out the bottom of page 4, the top of page 8 (regarding insurance), and all of page 9. Turn in only these three pages.
Release of Information
Click on the picture above to access the form.
The Release form is to be filled out in order for Dr. Adrianne to be able to talk with others at your request (i.e., past therapist, child's school, or a medical doctor). This form can also be used for Dr. Adrianne to have permission to get your past medical/mental health records.