4625 S Lakeshore Dr, #411, Tempe, AZ 85282
Client Forms
If you are new, please feel free to fill out these intake forms before our first session. We will review them during our first session. The link below will take you to another website where you can access all of my forms. Rest assured knowing that the forms are encrypted and HIPAA-compliant. If you are viewing this page from a computer screen, please scan the QR code below with your smartphone, and you may easily access/fill/sign the forms on your mobile device.
- New Client Intake Questionnaire
- Informed Consent for Psychotherapy Services
- Informed Consent for Telehealth (REQUIRED addendum for telehealth services)
- Release of Information (ROI) (REQUIRED addendum for telehealth services- must list an ER contact)
- Treatment Plan Signature Verification (for telehealth treatment plan reviews)
- Client Contact/Insurance Sheet
Or you may click on the link below (opens to Resolute's app) to complete all forms.
Current clients: you may access the forms at the link above anytime to update a specific form (e.g., client contact & insurance info sheet, authorization to release information, etc.).