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Blue Mountains
Blue Mountains

Intake Forms

If you're a new patient, please print out and complete the following form and bring it to your first therapy session.

Please note that I am not a Medicare or Medicaid provider and you will therefore not receive reimbursement from Medicare or Medicaid for my services. If reimbursement is very important for you, the best option may be to seek out a Medicare or Medicaid provider.

If you would like Dr. Thorsheim to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Note: To download Adobe Acrobat Reader for free, click here.

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Helpful Forms

Click here to view and print forms for your appointment.