Helpful Forms

• Docteur Thierry Jacquemin: http://drthierryjacquemin.com/

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

Client Intake Form

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:

Confidentiality and cancellation policy

AUthorization to disclose information

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