Please print and complete the following forms and bring them with you to the first session:
- Intake Wellness Client Self Report
- Client Demographic Information
- HIPAA – Client Intake Form
- Ivan Diller Psychotherapy Procedures
- HICFA 1500-90
- Credit Card Authorization Form
Please complete if there are other service providers that should be contacted for collaborative purposes, e.g. prescribing psychiatrist, school guidance counselor or social worker, etc.