Please note: I am legally required to collect your insurance copayment on the date of service. I am happy to accept cash, check or Paypal. If you desire to use a credit/debit card, please be advised that a $ 3.00 to $5.00 convenience fee will be added. Thank you.
If you're a new client, please complete the following forms and bring them to your first therapy session.
- Professional Disclosure
- Adult Intake Form
- Child 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:
AD/HD Assessment form. To be filled out if instructed by the therapist.
NICHQ Vanderbilt Assessment Scale
Note: To download Adobe Acrobat Reader for free, click here.
