HeartMath®

Helpful Forms

Helful Forms


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

icon_pdf – Intake Form

icon_pdf – Disclosure Statement

icon_pdf – Client Record


To coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

icon_pdf – Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here.

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Helpful Forms

Click here to view and print forms for your appointment.