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Specialized Evaluation and Assessment for Individuals
Couple Therapy Session

Client Forms

If you're a new client, please complete the following forms and bring them to your first session.

 

Client Information Form (all patients must complete)

HIPPA Compliance Form (all patients must complete)

Credit Card Authorization (all patients must complete)

Consent Form - Adult (select this form if you are 18 years of age or older and services are for yourself)

Consent Form - Minor (select this form if you are bringing your child or adolescent for services)

 

If you would like Dr. Lokken to coordinate care with another provider (for example, your psychiatrist, primary care physician, school, etc.), complete this form to authorize release of psychotherapy information:

Release Form 

 

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