New Patient Form
If you're a new client, please complete the following forms and bring them to your first therapy session.
Client Psychotherapy Intake Form
Limits of Confidentiality/Therapy Cancellation Policy
Client Consent and Agreement to Receive Psychological Services
Patient Bill of Rights/Responsibilities
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.
Integrated Mental Health Services LLC
Monday - Friday:
9:00 A.M. - 6:00 P.M.
Saturday & Sunday:
4 Abbey Lane
Newtown, CT 06470
Tel: (203) 270-0080
Fax: (203) 304-1191
* By appointment only; This office does not take walk-ins.
* Please note any messages left after 6:00 pm will not be checked until following business day.
* Please give 72 hours notice on prescription refills.
*We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website.
©2020 Integrated Mental Health Services LLC