Helpful Forms

New Clients: Please complete the following forms and email them to me prior to your first counseling session

IF YOU ARE SCHEDULING A COUPLES OR FAMILY THERAPY APPOINTMENT, PLEASE HAVE EACH PERSON READ AND SIGN THE "PRACTICE POLICIES & PROCEDURES" FORM, AND HAVE EACH PERSON FILL OUT A SEPARATE CLIENT INTAKE FORM. 

• Client Intake Form
• Practice Policies and Procedures
• Agreement for Telehealth Services

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 treatment information:

• Authorization to Disclose Information Form

 I AM NOT A MEDICARE PROVIDER. If you choose to work with me, you agree to be responsible for full payment of my services.  I am unable to submit claims to Medicare. 
IF YOU ARE 64 OR OLDER, PLEASE COMPLETE AND SEND ME THIS FORM:

• Medicare Eligible Client Responsibility
• Note: To download Adobe Acrobat Reader for free, Click Here