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