Client Forms

If you are new, please feel free to fill out these intake forms before our first session and bring them with you….These forms can also be filled out during the first session.

Client Intake Form

Information Sheet

Treatment Consent Form

HIPAA Consent Form

If you feel that you would like to collaborate your session with another provider, simply fill out the following form.

Authorization for Release of Information

 

Contact Today



1 Liberty Lane, Suite 103
Hampton, NH 03842

mary@gerizimpllc.com
(603) 758-1728

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