Jan Willer, Ph.D., Licensed Clinical Psychologist

Dear New Client:

Welcome to my practice. If you are reading this, you have probably made the decision to take a very important step by coming to psychotherapy.

It is crucially important to me that my clients are well-informed. I want you to know about important issues such as confidentiality, as well as the risks and benefits of therapy. Also, there are some important issues about how I run my practice that you need to know about. Finally, we need to iron out payment details in advance.

Even though I want you to be well-informed, I also want to be efficient. It is important to begin therapy as soon as possible. For that reason, I have developed a self-paced therapy orientation program that I would like you to complete before your first session. It will take you about 10 to 15 minutes to complete, but will save us spending at least a whole session in therapy reviewing this information. I hope that I will be able to answer many of your questions this way, as well as answer some questions that you didn't know you had, but were glad to get the answers to!

Self-Paced Therapy Orientation Program (10-15 minutes)
New Client Orientation: This is 6 pages of information that tells you about practice and payment policies, what therapy is all about, and confidentiality issues. You can just review this online and need not print it out. It is important legally and ethically for you to be informed about these issues before we start therapy. Doing this online helps us streamline the therapy process.

Signature Page: Please print out this page and sign.

Notice of Privacy Practices: This is a standard form required by federal law. Please print it out and sign.

Forms to Bring to First Session

Intake Form: Please print out this form and fill it out. This will help me zero in on your concerns more rapidly during your first session, allowing us to start addressing your issues sooner.

Credit Card Form: Please fill this out if

	You would like to pay your fee or copay by credit or debit card.
	You have an unpaid deductible for this year
	You have an out-of-state Blue Cross Blue Shield policy.

Release of Information Form: Please fill out a copy of this form for any of these situations that apply to you:

	You have seen another psychotherapist in the last 2 years
	You have gotten any psychotropic medications in the last 2 years or you are getting them now.
	You want a referral for psychotropic medications (leave the first part blank, and after I give you a referral, we can fill that part out)
	You have ever been in the hospital for any mental or emotional condition
	You would like me to send your primary care physician a very brief summary of your diagnosis and treatment (some clients like their physician to be fully informed about all the health care they are getting, others prefer to keep this information more private).
	If none of these apply, don't bother to print out or sign the form.

Click here for information on parking. I'm looking forward to meeting you in person.

Sincerely,

Jan Willer, Ph.D.