New Client Forms

There are a few New Client forms that will assit me in getting to know you and help you to understand my practice.  To save time in our initial session, please consider filling out the Intact and Treatment Agreement forms before coming in for your first session.


The Treatment Agreement includes a signature page which requires your signature and for couples--your partner's signature or for minors--a parents signature.

Note: You will need Adobe(r) Reader(r) to view PDF files. If you do not have it, you can download it for free.

Informed Consent Agreement.pdf
Adobe Acrobat document [98.5 KB]
No Secrets Policy for Couples
No Secrets Policy.pdf
Adobe Acrobat document [93.3 KB]
Intake Form.pdf
Adobe Acrobat document [106.1 KB]
Insurance Information and Good Faith Estimate
Insurance Form.doc
Microsoft Word document [41.0 KB]
Couple Questionnaires
New file download

Areas Served

133 North 4th Street

Easton, PA 18042 


409 Main Street

Chester, NJ 07930


Rhode Island

Via Telehealth

Phone: 908-235-8489 908-235-8489



Practice Forms

Informed Consent Agreement Couples.pdf
Adobe Acrobat document [177.5 KB]
Intake Packet.pdf
Adobe Acrobat document [184.9 KB]
Notice of Privacy Practices.pdf
Adobe Acrobat document [144.5 KB]
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© Paul J. LaChance