Intake Forms

If you're a new client, you may complete the following form and bring it to your first therapy session.  If you prefer, this form is also available for you to complete in my office, before your first session.

New Client Information

Treatment Agreement

Informed Consent for Telehealth

Credit Card Authorization

Consent to Text

Information About My Practice

HIPAA

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

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

Location

Availability

Monday:

9:00 am-5:00 pm

Tuesday:

9:00 am-5:00 pm

Wednesday:

9:00 am-5:00 pm

Thursday:

9:00 am-5:00 pm

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

No form settings found. Please configure it.