If you're a new client, please complete the following forms and bring them to your first therapy session.
For Employee Assistance Plan clients, please complete the following forms:
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 information:
Note: To download Adobe Acrobat Reader for free, click here.
We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.
By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.