Helpful Forms

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

• Informed Consent for Psychological Services
• Credit Card Authorization 
• Payment Policy for Therapy - Reference
• COVID-19 Informed Consent
• Telehealth Contact Information Form

If you would like Dr. Tilluckdharry to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization for Disclosure of Information

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