Appointment Forms

If you're a new client, please complete the following forms and email them to me or bring them to your first therapy session with Patricia Brawley, PhD, LPC.

 

• Client Psychotherapy Intake Form
• Limits of Confidentiality/Therapy Cancellation Policy

 

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 psychotherapy information:

 

• Authorization to Disclose Information Form
  

The law protects the relationship between a client and a psychotherapist and information cannot be disclosed without written permission.



Exceptions include:

 

• Suspected child abuse or dependant adult or elder abuse, for which I am required by law to report this to the appropriate authorities immediately.
• If a client is threatening serious bodily harm to another person/s, I must notify the police and inform the intended victim.
• If a client intends to harm himself or herself, I will make every effort to enlist their cooperation in ensuring their safety. If they do not cooperate, I will take further measures without their permission that are provided to me by law in order to ensure their safety.