Therapy Forms and Procedures for Treatment

For new clients, please print the forms below, read them and complete as thoroughly as possible. Bring these completed forms to your first session. Answer the questions to the best of your ability. This information will be helpful in understanding what has brought you to psychotherapy. Your responses are confidential and cannot be shared with anyone without your written consent.

If you have insurance, please bring your insurance card with you during your first visit. If you have a co-pay or are a full-pay client, please bring your credit card, check or cash. Payment is requested at the beginning of each session.

On your first visit, please arrive 15 minutes early to finalize all the paperwork so we can have quality time beyond the paperwork requirements to focus on the reasons that bring you to therapy.

• Agreement For Service

• Insurance Benefit Form

• Client Information Form

• Release Of Information Form

Confidential Information

All communication between you and Dr Jim Broderick, is confidential (for exceptions see Agreement for Service above). On occasion, in order to coordinate treatment, you may sign a release of information to coordinate care with another health provider or related professional.

All photos posted on this website are licensed from 3rd party photographers, and are not clients of Dr. Jim Broderick.