If you're a first-time client, please review and complete the following forms, bring them to your first session.

• Client Information Intake Form
• Practice Policies and Informed Consent to Treatment
• Insurance Form (ONLY if you have AZ Foundation Health Insurance)
• Signed Hippa Form (acknowledging you received a copy)
• Signed Grievance Form (acknowledging you have received a copy of grievance procedures)
• Sliding Scale Form (If you do not have AZ Foundation or out-of-network insurance benefits) 

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

• Consent for Release of Information Form
• Consent for Video Recording Sessions for the purposes of Supervision *(Please not that you DO NOT have to consent to your sessions being recorded and in the event that you do agree to have them recorded, your confidentiality will be strictly maintained)

Client Information: Intake Form
Practice Policies and Informed Consent
Megan, Vicktoria, & Kori's Sliding Fee Scale
HIPPA Information Form (for you to read and keep)
Hippa Consent Form (PLEASE SIGN & BRING TO SESSION)
Grievance Form (PLEASE SIGN & BRING TO SESSION)
Consent for Release of Information
Consent for Video Recording Sessions

Note: To download Adobe Acrobat Reader for free, click here.