Client Forms

If you have spoken to me about an appointment, here are the forms that you will need to get started.  You are welcome to print them and complete them prior to your appointment.

Dr M MCC Consent 1-2018

This form must be completed prior to our first meeting and it simply states that you agree to services by me for either yourself or a family member.  This form also discusses office policies with respect to payment for services, including handling of insurance, canceled or missed sessions, how payments can be made, and processes for unpaid accounts.  Dr. Matthews cannot meet with a minor without this consent being signed by parent(s).


For demographics like address, phone number(s), etc.

Emergency Contacts 1-2018

It is helpful to have an emergency contact on file, should there ever be a medical or psychiatric emergency.

Release of Information

This form is needed if you wish for me to share any information with anyone about you, such as your physician, a school counselor, a teacher, or someone else involved with you or your loved one.  This is only needed when you want information released.

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