For New Clients

Welcome.  If you are visiting this page, you and I have an appointment but have not yet met in person, so we need to do some paperwork.

I used to do the intake forms with people in my office during the first few minutes of the first session, but this chore is really better done in advance. That way we do not waste our time together on paperwork.

Please see the links below. If we are starting with therapy over the phone or online, please download, print, and complete the informed consent to telemedicine first.

Then download, print, and fill out the forms in the intake packet and get them to me before our first session, so that I can share them with my billing service, which verifies your insurance benefit, sends in my claims, and pesters me if I don’t supply the necessary information promptly. 

If possible, also make a copy of your insurance card, front and back, on one sheet.  A black-and-white photocopy is fine or a PDF, but please, no JPEGs, which don’t fax well. The intake packet and the insurance card, and the telemedicine consent, if applicable, are the stuff I need to get from you first.

A life history for you (or for your child if your child is the client) is important but less urgent.  There’s a separate link for an authorization form, which you will need to complete if you want me to speak with anyone other than your primary care physician (for whom the intake packet has a separate form). The client satisfaction survey invites you to give me feedback.  Your feedback is always welcome, though, whether spoken or written.

You can scan and fax the completed forms to me at (860) 231-1960.  Or you can attach the scans to an email and send them to [email protected].  Or you can mail the copies or the originals in a stamped envelope to Marcia Brubeck, 114 Somerset Street, West Hartford, CT 06110. Whatever works.

Thanks!

Informed Consent to Telemedicine

Intake Packet

Life History, Adult

Life History, Child

Authorization to Release Information

Client Satisfaction Survey