Helpful Forms


New Clients: . please complete the following forms and bring them 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. 


Only the person responsible for payment needs to complete the Payment Policy Form. 

Only the person who will be filing an insurance claim as the "identified patient" needs to complete the Client Insurance Form.

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:

 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:

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LOCATION

Appointment Times

Additional hours may be scheduled by appointment. Hours are in Central Time Zone

Monday:

9:00 AM -5:00 PM CST

10:00 AM-6:00 PM EST

Tuesday:

9:00 AM-5:00 PM CST

10:00 AM - 6:00 PM EST

Wednesday:

9:00 AM - 5:00 PM CST

10:00 AM - 6:00 PM EST

Thursday:

9:00 AM - 5:00 PM CST

10:00 AM - 6:00 PM EST

Friday:

9:00 AM - 3:00 PM CST

10:00 AM - 4:00 PM EST

Saturday:

By appointment only

Sunday:

Closed