Intake Paperwork for Individual Therapy

Be sure to speak with Cindy or Kathleen concerning fit and availability before filling out and submitting your paperwork.

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

    1. To bill your insurance directly, please go to O’BRIEN’S BILLING SERVICES to complete the “Patient Intake Questionnaire”.
    2. Before coming in for your first scheduled session, please print and complete the following forms: Confidential Personal Record, and HIPAA Signature Page and bring them with you to your first scheduled session.
    3. Please review HIPAA-Form. (no need to print this).

After you complete all paperwork, please send files to Cindy at or Kathleen at

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

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