New Client Forms & Disclosures
All general clients, please print and complete the New Client Forms Packet to bring to your first visit or for children please complete and bring the Child's New Client Forms Packet & No Subpoena Policy for your child's first visit.
Rates and descriptions for all services with a paypal portal to pay via credit or debit card are listed on the Services page. Scroll down the page until you find the rates you are looking for.
For Immigration Hardship/Asylum/VAWA/UVisa Evaluations, please complete the New Client Forms Packet, the Extreme Hardship Report Disclosure and the Immigration Hardship Evaluation Intake Form or the Asylum/UVisa/VAWA/Spousal Narrative.
You will also need to complete a Release of Information for your immigration attorney at the time of your evaluation.
If you are seeking pet assisted therapy for yourself or pet assisted play therapy for your child please also review and complete the Pet Assisted Release Form. There is no additional fee for this service and it is available upon request with one of our therapy pets. Read More Here >>
If you are currently involved in a personal/family court case or custody case and are seeking expert assessment or testimony - not treatment, please review our Court Testimony Policy Form. Our practice is designed to provide clinical treatment that is confidential and in the best interest of the client, not to be used to anyone else's advantage in a court of law. In treatment, we adhere to the protection of our patients under the Florida statutes therapist/patient privilege and federal HIPPA law, and the ethical guidelines of the APA & AAMFT.
Forensic mental health assessments are for clients not in treatment at this practice and are designed only to assist the courts - not treat symptoms. In forensic mental health and family assessments, the patient waives his or her right to confidentiality from the courts. Contact our legal department for more details. Therefore, we do not provide psychotherapy for court or USCIS involved cases whom are being assessed at this practice.
Request to Release Information
All requests to release medical information from this office must be made by the client directly via the form linked below. Be sure to provide the contact information of the physician or entity to whom you wish to forward your information.
Please note that psychotherapy notes are not considered to be part of your accessible information and will not be shared with anyone, as per HIPAA guidelines and therapist/patient privilege.
Cost of copying and mailing information must be paid in advance to any release of information. Allow 1-2 weeks for receipt of signed release and forwarding of any medical information summary as directed.
Release of Medical Information Form
Court Appearance/Testimony Form
Online Counseling/Telemedicine/Telehealth Therapy & Assessments Consent
If you are unable to download or print pdf files, please contact our office for paper copies. Our office manager, Lynette, (shared with Max Story Law) will be happy to provide you with the forms that you require.