Documents

Intake Forms:

Before our first appointment, or to re-start therapy after a break, new clients need to download and fill out these intake forms.

Please download each form, print it, fill it out, and sign where indicated.

When I am able to resume in person meetings, please bring the filled out forms with you to your first appointment.

COVID-19 PANDEMIC AND QUARANTINE:
Because I’m currently unable to meet new clients in person, some people prefer to send me their intake documents via email. As noted in my Office Policies document, there are some risks to using email, and people using email should understand and accept those risks. My email is HIPAA compliant and offers end to end encryption:
andrea (at) somaticwise (dot) net
Otherwise, please send them to my office via US Postal mail,
Or make arrangements to drop them off at my office.
You can also fax the paperwork to me–just ask me and we’ll make arrangements.

In person appointments may come in 15 minutes early and fill them out in the waiting room, if they prefer. (This is unavailable during COVID-19 pandemic and shelter at home orders).

For tele-health, I use a HIPAA compliant platform called SecureVideo.com.

Here are the documents:

Initial Overview and Contemplation_compressed

Andrea’s Office Policies Aug 2019_compressed

SE Informed Consent PDF_compressed

Updated Notice of Privacy Practices_compressed

This document is the consent form for tele-health sessions (consultation or therapy):
SW TeleHealth consent form

The following document is only required for COUPLES or FAMILY THERAPY:
SomaticWise No Secrets Couple Family_compressed

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