Forms

Click on the files to download and complete prior to your first session.

HIPPA Form for you to keep: hippa-brochure-dragonfly

Release Form of Information for Insurance or any other person you would like involved in therapy: jayde-authorization-for-disclosure-of-mental-health-information

Confirmation of Privacy Form and Informed Consent: confirmation-of-privacy-notice-and-informed-consent-and-professional-disclosure-statement

Insurance and Payment Form: insurance-and-payment-form

Adult/ Couples Intake Form: adult-background-form

Child/ Teen Intake Form: child-adolscent-background-form

Only Complete for your Therapist

Informed Consent for Jayde Young: jaydeinformedconsent

Informed Consent for Ashley Applewhite: professional-disclosure-statement_ashley-applewhite

Informed Consent for Adrienne Dimas: adrienne-dimas-disclosure-and-informed-consent