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Blue Mountains
Blue Mountains

New Patient Forms

Once you have an appointment scheduled with Dr. Folts, please complete the forms below which will expedite the paperwork we have to complete during the first session.  It will take approximately 10 minutes to fill out paperwork and other administrative tasks before we will begin to develop a treatment plan together. There are a few other forms you will need to sign when you come in that are not on our website including :

1.  Consent for Treatment form (clarifying expectations of our counseling relationship)
2.  HIPPA policies for our office. 
3.  Release of Information (if needed)
4.  Consent for treatment of a minor (if needed)
5.  Treatment planning forms 

You will receive a copy of our HIPAA  (Health Insurance Portability and Accountability Act)  policies as well as our offices policies. HIPAA is a federal law protecting your health information (Protected Health Information).  The Notice of Privacy Practices describes how we protect your PHI in accordance with applicable laws and the NASW Code of Ethics.

I have included 2 forms here on the website that will make the process faster.  If you are a new client, please complete the following forms and bring them to your first therapy session.  If you are a couple coming in together,  fill out these forms individually.

Client Psychotherapy Intake Form 

Life History Questionnaire

 I look forward to meeting you in person.


Note: To download Adobe Acrobat Reader for free, click here.


Helpful Forms

Click here to view and print forms for your appointment.