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
If you would like us 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
|Client Psychotherapy Intake Form|
|Limits of Confidentiality/Therapy Cancellation Policy|
|Authorization to Disclose Information Form|
Note: To download Adobe Acrobat Reader for free, click here .
The law protects the relationship between a client and a psychotherapist, and information cannot be disclosed without written permission.
Your privacy and confidentiality are extremely important and we will respect and protect them at all times.
Please note that the law requires us to notify the authorities in certain specific instances including:
- Suspected child abuse or dependent adult or elder abuse, for which we are required by law to report this to the appropriate authorities immediately.
- If a client is threatening serious bodily harm to another person/s, We must notify the police and inform the intended victim.
- If a client intends to harm himself or herself, we will make every effort to enlist their cooperation in insuring their safety. If they do not cooperate,we will take further measures without their permission that are provided to us by law in order to ensure their safety.
Call Thomson Therapy Center today at (734) 994-8120 for your Free Consultation or for answers to your questions about
Individual Counseling, Relationship Counseling and Addiction Treatment in Ann Arbor.