PORTLAND THERAPIST:Amy Ponteri, LPC, ATR-BC
  • Portland Therapist
  • What Can I Expect from Therapy?
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  • SE Portland - Contact
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  • Initial Paperwork
  • Clinical Supervision
I ask that you please print out the New Client Questionnaire (note for child or adult) and bring it, completed, to your first appointment. If you are unable to print it out, I'm happy to send it to you via regular mail. If there is anything that makes you feel uncomfortable or that you're not sure how to answer, go ahead and skip that part, and we can review it together when we meet.

New Client Questionnaire - Adult
new_client_questionnaire_-_adult.docx

New Client Questionnaire - Child/Adolescent
child_teen_new_client_questionnaire.docx

I will have the following forms available at our first appointment, though I encourage you to review them ahead of time:
Consent to Treatment 
informed_consent.docx

My Professional Disclosure Statement
professional_disclosure_statement.docx

Release of Information
/uploads/1/6/3/3/16339748/roi.docx

HIPPA Privacy Practices
/uploads/1/6/3/3/16339748/hipaa_notice_of_privacy_practices.docx

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