First Session Forms

Please print and complete these forms prior to your first individual or group session. If you have questions about any of these forms, just fill out what you can. I will be happy to answer your questions when we meet.

Thanks!

Don Baker, MA, LMHC

Founder of Unpacking ADHD

Required Forms

New Client Intake Form
Please complete a separate form for each person that will be meeting with Don Baker, MA, LMHC.

Disclosure & Consent for Services 
Please complete a separate form for each person that will be meeting with Don Baker, MA, LMHC.

HIPAA Notice and Receipt 
Please provide signatures for each person that will be meeting with Don Baker, MA, LMHC.

Insurance and Credit Card Consent 
Please fill out this form completely and notify Don Baker, MA, LMHC if/when any of this information changes.

 

Optional Form

Release of Information
Authorization for release of information to specified parties (i.e physicians, spouses, etc.)

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