Forms

Please tap the links below to download the new patient forms in PDF format. Next, read them, sign each form, and email them back to me safely and securely using this link: https://sendsafe.to/Cdohertyphd@gmail.com

  • Informed Consent for In-Person Services During Covid-19 Public Health Crisis

    This document contains important information about our decision (yours and mine) to resume in-person services in light of the COVID-19 public health crisis. Please read this carefully and let me know if you have any questions. When you sign this document, it will be an official agreement between us.
    Download PDF

  • Important Policies

    Please read and sign.
    Download PDF

  • Statement of Informed Consent

    Please take a few minutes to read the important information provided on this handout. After you have finished reading this document carefully, please sign in the appropriate space and discuss any questions that you have with Dr. Doherty.
    Download PDF

  • Authorization for Release of Information

    As a client (or as the parent or guardian of a client under 18 years of age) of Dr. Doherty, you are entitled to the privilege of confidentiality, which means that, generally, no information will be released regarding psychotherapy sessions without your written consent. Exceptions to the privilege of confidentiality are that a therapist may disclose information deemed necessary to protect clients or others from imminent physical danger, in cases where child or elder abuse is reported or suspected, or upon court order.
    Download PDF