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Forms

The forms with an asterisk (*) are the forms most people will need to review or fill out prior to our first meeting. To view, click on the titles in bold.

I have form-enabled these documents, so you can fill out and digitally sign them on your computer using Adobe Acrobat Reader DC (which you can download at Adobe Acrobat Reader DC – Note: Adobe has some optional offers which you can uncheck if you don’t want them). I will send you an encrypted email (probably via Hushmail) that you can use to securely send the completed forms to me before our first session.

*Office Policies and General Information Agreement for Psychotherapy Services.
All persons who receive treatment services from me must review and sign the Office Policies & General Information Agreement for Psychotherapy Services. This form is sometimes called an informed consent form and includes information on rights and responsibilities.
* Biographical Information-Intake Form.
This is a standard questionnaire I ask most adults to fill out prior to our first session.
* Consent to Touch Form.
I practice somatically (body-oriented psychotherapy). Sometimes this will involve touch, but only with your permission.
* Audio-Video Recording Release Form.
I record all sessions. This enables me to review our sessions as needed. Sometimes I will bring portions of a previous session into a later session.
What I Want Out of Therapy or Consultation.
People come to therapy or to consultations for a variety of reasons. This is not a required form, but filling it out could be helpful in getting your therapy off to a productive start.
Adolescent Questionnaire
This questionnaire is to be filled out by parents or guardians when the adolescent is to be the focus of treatment.
Skills Group for Adult Survivors of Childhood Trauma Agreements.
This agreement is to be signed by each member of the short-term Skills Group for Adult Survivors of Childhood Trauma.
Adult Survivors of Childhood Trauma Group Agreements.
This agreement is to be signed by each member of the ongoing Adult Survivors of Childhood Trauma Group.
Authorization to Exchange Confidential Information -- Cotati office
Authorization to Exchange Confidential Information -- Mill Valley office
Under most circumstances, I am not allowed to share information with others without your permission. This is the form you will need to fill out and sign in order for me to communicate with other parties. Examples of others you may wish for me to communicate with or receive records from include medical providers, clergy persons, community organizations, other therapists, and friends or family.
Informed Consent for a Visitor to attend a Psychotherapy or Consultation Session
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Informed Consent for the Treatment of Traumatic and Dissociative Disorders
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Informed Consent to use Clinical Hypnosis
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Informed Consent to use Clinical Hypnosis for Dissociative Disorders
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Caregiver's Authorization Affidavit
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