Forms and Worksheets | Inner Life Adventures

Here you will find the paperwork we use in the office, so that you can have a copy to read and examine before our first session.

Required Forms

All intake paperwork is now online. You will receive a link to the intake paperwork when your intake appointment is scheduled. The forms below are provided, if you would like to read them ahead of time.

Notice_of_Privacy_Practices (HIPPA) You don’t need to print if you don’t want to, but please read. In the intake packet you will sign that you have read and understand it. There are printed copies in my office as well.

Depending on the work we will do, please complete one of the below Detailed New Client Questionnaires:

For individual work: Detailed New Client Questionnaire (Word doc) or Detailed New Client Questionnaire (pdf).
For couples/relationship work (each person complete individually): Couples-Relationship New Client Questionnaire (pdf) or Couples-Relationship New Client Questionnaire (Word doc)
For both individual and couples work, drawing a Genogram (map) of your family can be helpful (but not required). Here are Genogram instructions.

Optional Forms

Consent to Release and Retrieve Information – Everything about our work together is legally confidential with a few exceptions outlined in the Disclosure Statement. If you want me to talk to anybody else about our work such as your primary care physician, family, friends, partner, teachers, other therapists, etc… for any reason, this form needs to be completed.

Optional Worksheets

Some clients find it helpful to have concrete tools and worksheets to work on at home in between sessions. Here are some resources I use from time to time. Use them if they are helpful to you.

Relationship/Communication

ACT – Acceptance and Commitment Therapy Resources

Misc