Assessment Forms

If you're a NEW CLIENT,  please print and complete the following forms and bring them to your first therapy session. As email/internet may not be secure, you can consider password protecting your documents.

• Client Information Questionnaire
• Client Psychotherapy Intake Form
• GAD 7 / PHQ 9
• Limits of Confidentiality/Therapy Cancellation Policy

In-person protocol: Please review AHS COVID19 screening questionnaire, and in-person protocol: 

• AHS Screening Questionnaire
• In Person protocol

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize Release of Information.

• Authorization to Disclose Information Form

If you're a new client who will only be doing TeleHealth Counselling via an online platform, please complete the Client Information Questionnaire above, the Client Psychotherapy Intake Form and the Virtual Consent form below.  Ensure that you read the instructions for our virtual counselling below.

• Instructions for Virtual TeleHealth Counselling
• Virtual Care Consent Form

NOTE: For NEW TINNITUS CLIENTS only: The Tinnitus Assessment Package "TAP" (forms and questionnaires) are located on the Services page of the HopeForTinnitus Website: http://www.hopefortinnitus.com/services.htm

As the tinnitus website is currently 'under construction',  you can access the required forms directly below:

• Tinnitus Interview
• Tinnitus Handicap Inventory
  
• Khalfa Hyperacusis Questionnaire
  
• Dizziness Handicap Inventory
  
• Tinnitus Cognitions Questionnaire
  
• PHQ9 - GAD7 Measures
  
• Stress Symptom Checklist
  

Thank you in advance for taking the time to complete the documents.

Note: To download Adobe Acrobat Reader for free, click here.