New Client Paperwork
Paperwork can now be completed online through Jane’s client portal. Jane will email you a link once the date and time or your first session has been agreed. In the case of couples therapy, BOTH partners need to complete their own paperwork. PDF copies of these documents are available on this page for your reference.
- Demographic, insurance information and consent for treatment
- Release for emergency situations
- Contract for therapy (Client Rights and Responsibilities)
- Client Intake Form
- Release for information
- Notice of Privacy Practices
- Sliding Scale Discount Policy
The following paperwork is required for clients undertaking EMDR therapy:
Please note: The Dissociative Experiences Scale (DES) was developed by Eve Bernstein Carlson, Ph.D. and Frank W. Putnam, M.D. This copy was purchased from the Sidran Institute and is provided here for clients of Jane McCampbell to complete as part of their preparation for EMDR therapy. It is not intented for general download or for publication on other websites. If you require a copy for such purposes, please contact the Sidran Institute directly.
Attending therapy for the first time can be anxiety-provoking. Jane understands that anxiety and avoidance are a natural part of the process, but asks that you please be respectful of her schedule by letting her know a minimum of 48 hours in advance of your appointment time if you are not intending to show (note that cancellations for Monday appointments must be received by noon on the preceding Friday). You can do this by voicemail on 612 414 0383 or send a message through this website. Late cancellations and no-shows for the first session will be billed the full session fee.
If you have any questions as you are filling out your paperwork, please note them down so that you remember to ask Jane when you come for your first session. You can always leave a question blank or a document unsigned until you have the opportunity to ask for more information.