Bodhgaya-India,-Lotus-Pond                              Bodh Gaya, India

Please download these forms, fill them in and bring them to the office when you come for your first visit. If you want your record from another psychotherapist, physician, hospital or clinic to be sent to me, or if you want me to make part or all of your file at my office available to someone else, such as your physician, please fill in and sign the Release of Information form. Please note that any consent given can be withdrawn by you at any time. It is the policy of the Office to have your credit card information on file, before an appointment can be scheduled, for payment of co-pays, deductibles, no-shows and missed appointments, and for cancelled appointments when less than 24 hours’ notice is given. Your collaboration in providing this information is appreciated.

  1. Intake Forms for all Clients Except Medicaid Clients

  2. Intake Forms for all Medicaid Clients

  3. Release of Information (if you wish to have it sent to your physician)

Comments are closed.