If you’re a new client, please complete the following forms and bring them to your first therapy session.

• Intake Form – English version
• Intake Form – Spanish version
• Limits of Confidentiality – English Version
• Limits of Confidentiality – Spanish Version

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Disclosure form- English Version Only

If you are health care professionals and would like to make referrals to us, please complete the Referral Form and fax it to (203) 248-5312. Thank you.

• Referral Information Form

Please note, this referral form is for physician, case manager, social worker, hospital, or other healthcare professionals use.