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.
Different browsers treat these forms differently. At this writing, for example, Chrome opens the forms, allows you to type and print, but not to save the typed information. Internet Explorer allows typing, printing, and saving the typed information to your computer. Please check for yourself on your computer.
Forms to bring to your first session
If you are seeing Deborah Tucker, please bring these forms to your first session. They will also be in the waiting room if you would prefer to fill them out there. In that case, please arrive early, since they do need to be completed before we begin. If you are seeing another therapist, please ask them if they use these forms.
New client informed consent -- please fill this out, read, sign, and bring to your first session. This form explains the therapy process. If you have any questions, please feel free to ask them at your first session. (You can fill this out on your computer, if you like, and then print it. Please do not email, for privacy reasons.)
Client information form -- please fill out this form as completely as possible. It will help us use our first session more productively, and may help you clarify what your goals for therapy are. If you are unsure about any of the questions, please feel free to discuss this. (You can fill this out on your computer, if you like, and then print it. Please do not email, for privacy reasons.)
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.)
Optional forms to bring to your first session
Authorization to Release Information form -- if you wish us to release your records to your doctor, other therapists, etc. This includes your health insurance company if you want your insurance billed.
Detailed Intake Information -- if you like, you may download and fill out this form to bring to your first session. This is a detailed symptoms and issue checklist that you may or may not find useful, depending on your situation. It is completely optional. (You can fill this out on your computer, if you like, and then print it. Please do not email, for privacy reasons.)
Credit card authorization -- you may use this form if you wish to authorize your credit card to be billed, either once or recurrently.
Other forms related to your Personal Health information
For use as needed. These forms are for clients of Deborah Tucker only. If you are seeing another therapist, please ask them for their version of these forms.
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.