Client Forms & Information

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

• Client Psychotherapy Intake Form
• Informed Consent for Psychotherapy Services
• Informed Consent for Coaching Services
• HIPPA Informed Consent

Sexual Therapy Assessments

• Background History
• Physical History
• Sexual Assessment

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

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

---

Rates & Insurance

Rates

Please discuss fees with Dr. Symington

Insurance

Our practice is fee for service, which means we don’t directly work with insurance companies. While you are responsible for payment, we do supply filled out CMS-1500 forms (universal health insurance form) that you can submit to your insurance company for out-of-network reimbursement.

Payment

Cash, check and all major credit cards accepted for payment.

Cancellation Policy

We require at least 24 hours notice for any cancellations to avoid being charged for the scheduled session.

Schedule Online

Request a therapy appointment online here.

Contact

Questions? Please contact me for further information.