Thank you for coming to see me! I hope that I can provide you with a meaningful and effective source of support as we work together to make life better for you and/or your family. There are several forms on this page that I would like you to print out, complete, and bring with you to your first appointment; if printing these forms is inconvenient for you, paper copies are available at Mt. Logan Clinic during regular business hours. If you have any questions at any time, please do not hesitate to contact Haley or Brittany, the receptionists at Mt. Logan Clinic, or me; we will do our best to give you whatever information you need.
Please complete the applicable form(s) for each person who is coming in:
- The financially responsible party for each patient must print out, complete, and sign the intake financial forms before the patient will be seen for the first appointment.
- If you are an adult coming in for yourself, please complete the adult intake form. If you are coming in as a couple, I would like each person to complete the adult intake form independent of each other, please.
- If your child or adolescent is coming, I would prefer that parent(s)/caregiver(s) complete the child intake form, please.
- If your adolescent child is coming, the adolescent should complete the adolescent intake form. Please note that the adolescent should complete the adolescent intake form and parent(s)/caregiver(s) should complete child intake form.
- If your child is coming to the Adolescent DBT group, please complete the adolescent dbt agreement.
- If you are coming to the Adult DBT group, please complete the adult dbt class agreement.
- If your child or adolescent has divorced parents, please complete the divorce addendum.
- Please review the entire information and agreement form. This is the contract between you and me that details all services and charges provided. A paper copy is also available to you at Mt. Logan Clinic during normal business hours.