New Client Forms

Dr. Rae Sandler Simon, Psy.D, LLC
3773 Cherry Creek N. Dr., Suite 735
Denver, CO 80209
p 303.552.0472 | f 303.322.2292 | drsimon@livenlovewell.com

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Thank you for taking the time to review and fill out the following forms prior to our first meeting.
Please email or call me should you have any questions.

Forms for your review. Please do not bring to our first meeting:

Notice of Privacy Practices (Brief Version)

Forms to download, print and complete. Please do bring to our first meeting:

- INDIVIDUAL ADULT Client Paperwork:

1. Intake Packet

2. Disclosure Form

3. Individual Adult Intake Questionnaire

4. Financial Information Worksheet

5. HIPAA Consent Form

- COUPLES' Client Paperwork:

1. Couples Intake Packet - both sign the same form

2. Disclosure Form - both sign the same form

3. Cover Sheet - both sign the same form

4. Couples' Intake Questionnaire (Each person completes one)

5. Financial Information - both sign the same form

6. HIPAA Consent Form - both sign the same form