Forms for downloading
We have placed our intake and informational forms here, so that you may download, read, and fill them out at your convenience. Each therapist's practice is separate and independent; if your therapist hasn't mentioned the availability of these online forms, you may want to ask if this is the form they use.
To view these forms, you will need Adobe Acrobat Reader. This free software is available from the Adobe Acrobat site.
Click here to read more about some of the issues involved in using insurance, particularly managed care, for psychotherapy services. Please feel free to call or email us with any questions you may have, or simply discuss them at your first session.
^ TOPForms to bring to your first session
Intake form -- please fill this out, read, and bring to your first session. (Open the form, click on the "hand" tool, and you can fill the form out before you print it!)
Acknowledgement of Receipt of NPP -- if you are seeing Deborah Tucker, please sign and bring to first session. As of April 14, 2003 we are required to ask for this form, which documents that you have read the Notice of Privacy Practices below. If you are seeing another therapist, they will provide their version of this form.
Notice of Privacy Practices (NPP) -- If you are seeing Deborah Tucker, please read. You don't need to bring this with you; you may wish to keep it on file. If you are seeing another therapist, they will provide you with a copy of their Notice of Privacy Practices. As of April 14, 2003 we are required by federal law to notify you of our privacy practices. (These are the same type of forms that every medical professional must provide. We have tried to make ours very clear and understandable. Please be sure to ask your therapist if you have any questions about this form.)^ TOP
Optional forms to bring to your first session
Detailed Intake Information -- if you like, you may download and fill out this form to bring to your first session. Some people prefer to save time by doing this; others do not. It's completely up to you. It covers a wide range of areas, and some may not apply to your situation.
Authorization to Disclose Information form -- if you wish us to release your records to your doctor, other therapists, etc.
^ TOPOther forms related to your Personal Health information
These forms are for clients of Deborah Tucker only. If you are seeing another therapist, please ask them for their version of these forms.
Request to restrict certain uses and disclosures of Personal Health Info.
Problem report form. If there is a problem with treatment, billings or anything else about my practice, please let me know, either in person or in writing.