Intake Paperwork for Individual Therapy

Thank you for taking the time to complete this paperwork. Please follow the next three steps. All answers are confidential.

  1. In order to bill your insurance directly, please fill out the following form for O’BRIEN’S BILLING SERVICES by clicking this link: Form to submit
  2. Before coming in for your first scheduled session, please print and complete the following forms: Confidential Personal Record, Individual Therapy Agreement and HIPPA Signature Page and bring them with you to your first scheduled session.
  3. Please review HIPPA-Form. (no need to print this).

If you have any questions, please call our office at 315-436-5428.