Jassy  Timberlake, M.Ed., LMFT
Sex and Relationship Therapy for Couples and Individuals
Jassy Timberlake, M.Ed., LMFT
413-303-0095
19 Center Court
Room 1A
Northampton, MA 01060
info@jassytimberlake.net
Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

  • Client Psychotherapy Intake Form
  • Limits of Confidentiality/Therapy Cancellation Policy

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

  • Authorization to Disclose Information Form

Client Psychotherapy Intake Form  
Limits of Confidentiality/Therapy Cancellation Policy  
Authorization to Disclose Information Form  
Insurance Information Form  

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