Forms

Registration form for individuals: Online form  or PDF Word 
Your contact information, agreement on confidentiality, fees, missed sessions.

Registration form for couples: PDF
As above.

Intake questionnaire: Word PDF
Background information about your history: medical, therapy, family, medications, and current goals.

Self-study: Word PDF
Useful questions to help you focus on what you want from therapy at this time

These forms are quite helpful and save us time in the 1st session. If you can, please fill them out and bring them with you.

Online forms

These questionnaires are done on your browser. They are used for intake and to help track progress. The results go to my personal database. Scores do not appear here. Measures on the Questionnaires tab do give you feedback.

1. Symptom Checklist 90 – long form

2. Cross Cutting symptom questionnaire 23 item

3. Rand Health Status Questionnaire

4. Depression (PHQ-9) (or Mind over Mood)

5. CESD-R Depression

6. Anxiety GAD7  (or Mind over mood)

7. Anger long form

8. PTSD PCL-C

9. Pain Disability Questionnaire

10. Pain Coping Inventory

11. Relationship satisfaction

12. Couple’s adjustment (Dyadic adjustment scale)

13. Couple’s coping

14. WHODAS 2 General wellbeing

15. AHDH Self Rating Scale

16. Values questionnaire