View of a mountain range - Yosemite National Park - and grey-pinkish-blue sky with clouds.
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Forms for new clients



General information about my practice

(These forms contain general information about my practice and you do not need to print them.)

Privacy Policies

Therapy Client Agreement



Forms you will need for your first appointment

You can either bring these with you, or email them to me prior to the first appointment.

Consents Form (needs your signature)

New Client Information (Microsoft Word file)
New Client Information (PDF file)

Intake Form (Microsoft Word file)
Intake Form (PDF file)



Other Forms


If you would like me to speak to another provider you will need to sign a separate information release form. (You do not need to sign this form prior to your first appointment - only if you wish for me to speak with another provider.)

Consent to release information




Tel. / email 413-341-6689 or eva@therapy21st.net.

409 Main St., Suite 250, Amherst, MA
6-8 Crafts Ave., Suite 2R, Northampton, MA