Practice Forms

bipolar therapy therapist

Wait List Form

Sometimes when my schedule is full, I’m not able to schedule appointments for new patients.  If you’ve spoken with me and learned this is the case and you are interested in waiting for an available appointment, please click on the Wait List Form link, complete the form and submit to me electronically.

Once received, I’ll get back to you when I anticipate being able to work you into my schedule.  DO NOT SUBMIT IF YOU AND I HAVE NOT FIRST COMMUNICATED BY PHONE OR THROUGH EMAIL.

Private Practice Information and Guidelines

This same form is e-mailed to new patients when they initially register through the Patient Portal.  However, you’re welcome to review it if you want to learn more about my practice policies before initiating contact.  

Release of Information

To be used when you want to provide me with permission to communicate with an outside party regarding your treatment.  It can also be used to obtain information from outside providers (current or previous treatment records).  Feel free to print and use this form as needed.

Patient Waiting List Form

Sometimes when my schedule is full, I’m not able to schedule appointments for new patients.  If you’ve spoken with me and learned this is the case and you are interested in waiting for an available appointment, please complete and return the form to me.  The content of the form will help me to assess your needs in relation to future treatment.  Once received, I’ll get back to you for further planning.

Bipolar Support Group Interest Form

To be completed if/when we are meeting for a group screening appointment where we are discussing your potential participation in one of the bipolar support groups.  The form should not be completed if I already know you by virtue of your having previously been in treatment with me.

 

Pre-Interview Bipolar Disorder Questionnaire

Sometimes when meeting with a new patient who is being seen specifically for bipolar disorder-related concerns, I like to gather comprehensive information through an in-depth questionnaire.  Before you spend time on the questionnaire, you should speak with me to determine if it is necessary.