Forms Overview

The following forms are among those used in my practice and are provided here for review.

The actual forms are available for new clients through the secure client portal. 

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Notice of privacy practices


A standard document in the ongoing efforts towards HIPPA compliance, this notice provides information regarding how your Protected Health Information is used and distributed.

Professional disclosure statement

Provides concise information regarding my philosophy, educational background, clients rights and, most importantly, how to get a hold of the Oregon Board of Licensed Professional Counselors and Therapists should you have any concerns.

Consent for transmission of protected health information through non-secure means

Not required for treatment, however this form allows communication through common, although non-secure, means such as email and texting.