For Alan Pogue

To save you time and hassle, you can fill out each of these forms before coming to your first session.

Intake Form

The intake form gives me some basic information about your background and therapeutic needs.

Informed Consent

The informed consent document notifies you of your privacy rights related to any work we do. The consent form will be signed in the office, but you may review it before your visit by clicking the link below.

Release of Information

The final form is a release of information which allows me to discuss some of your private information with individuals you specifically designate (such as a doctor or family member).

Note: This form is entirely optional. DO NOT SUBMIT a Release of Information unless you are sure you want me sharing information with someone.

* Required
    This is a required question
    This is a required question
    This is a required question
    Never submit passwords through Google Forms.
Request edit access