If you're a new client, please complete the following forms and bring them to your first therapy session.
- Intake Form - English version
- Intake Form - Spanish version
- Limits of Confidentiality - English Version
- Limits of Confidentiality - Spanish Version
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:
If you are health care professionals and would like to make referrals to us, please complete the Referral Form and fax it to (203) 248-5312. Thank you.
Please note, this referral form is for physician, case manager, social worker, hospital, or other healthcare professionals use.
Note: To download Adobe Acrobat Reader for free, click here.