Our Forms

You can bring paperwork to your first appointment, or email it to info@birchpsychology.com, or to your specific clinician

All clients should complete a Consent Form, specific to your clinician, and a Receipt of Privacy Rights form (which indicates that you have reviewed the Notice of Privacy Rights). The Authorization to Release Information Form should be completed if you'd like to authorize an exchange of information between Birch and an outside organization or person. All clients should also complete a background form:

Parents of children seeking therapy (child, family or group) or assessment services should complete the Child Background Form (in addition to forms listed above under all clients). 

Adults seeking individual therapy should only complete the Adult Background Form (in addition to forms listed under all clients). Adults seeking family or couples therapy should only complete the Family & Couples Initial Form (in addition to forms listed under all clients)

Professionals/providers seeking a convenient and more efficient method of referring an individual, and establishing collaborative communication for the purpose of continuity (with permission), can complete Birch's Referral Form.

Pediatric providers are welcome to utilize the following resources: Decision-Making Form (to aid with steps to take relating to mental health concerns following a brief assessment using the PHQ-9: http://www.cqaimh.org/pdf/tool_phq9.pdf) and a Coping Tools Resource