Helpful Forms

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

Consent Form

Notice of Privacy Practices

Adult Receipt of Privacy Practices

Child Receipt of Privacy Practices

Information Form (select appropriate age)

Adolescent Information Form

Child Information Form

Sleep Intake Form (select appropriate age)

Adolescent Sleep Intake Form

Child Sleep Intake Form

Infant Sleep Intake Form

Sleep Diary (select appropriate age) – Please complete for 7-10 days prior to your first session.

Adolescent Sleep Diary

Child Sleep Diary

Infant Sleep Diary

Epworth Sleepiness Scale (adolescents only)

Email Authorization

Social Media Policy

Patient Bill of Rights

If you would like me to coordinate care with another provider (for example, your  primary care physician), complete this form to authorize release of information:

Release of Information Form

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