Forms

Forms

Both print and fillable forms are available.

Click here for instructions on how to download or use the fillable forms.

Forms to Print

Select these forms to print and fill out to bring with you to your first appointment.

1. Intake Packet

2. Intake Form

3. Client-Therapist Agreement 

4. Telehealth Consent Form

5. Good Faith Estimate Form

6. Consent to Video & Zoom Participation

7. Consent Form for Alternate Communication 

8. Authorization to Release Medical Information

9. Ketamine-Assisted Psychotherapy Consent Form

Miscellaneous Forms 

1. Recurring Payment Authorization Form 

2. Questions To Ask Your Insurance Company

3. Current Family Assessment

4. Family of  Origin Assessment

5. Notice of Privacy Practices | Patients Rights & Responsibilities

Fillable Forms

Select these forms to fill out online, and email to info@ftisb.org prior to your first appointment.

1. Intake Packet

2. Intake Form 

3. Client-Therapist Agreement 

4. Telehealth Consent Form

5. Good Faith Estimate Form 

6. Consent to Video & Zoom Participation 

7. Consent Form for Alternate Communication

8. Authorization to Release Medical Information