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

Teletherapy Consent Form

Consent for Treatment

Personal History Form

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


SUPPLEMENTAL FORMS

Complete these only if requested by Dr. Karcher.

Release of Information Form