Intake Documents
online in ca • in-person & online in va
INSTRUCTIONS
In order to help you with whatever you have going on, I need to know what’s going on. The forms below ask for your personal history in specific areas so I can better understand your situation. These also provide your consent to see you virtually, and to provide treatment.
Any information provided here or in sessions is purely confidential and will never be shared with anyone.
1 - please fill out the forms below
Credit Card Authorization Form
2 - please REVIEW THESE FOR YOUR INFORMATION
HIPAA Notice and Privacy Practices
Office Policies and Fee Schedule
3 - SENd BACK TO ME at least 24 hours before our session
Email to: annekarcherphd@gmail.com