WELCOME! If you're a new client, please fill out all forms listed on this page with the exception of The Insurance Verification Form and email to me at least 48 hrs prior to your initial session, or print all forms, fill them out and bring them to your initial consultation. Please contact my biller in order to fill out the Insurance Verification Form with her. Her information is listed on the New Patient Information tab. Thank you
Client Intake Form
Client Confidentiality Form
Patient Info Sheet
Patient Info Update Sheet
This form is to be used for the continuing treatment for individuals that I am currently treating. This is used to verify your ongoing insurance: only used in the month of January for the new year.
New Patient Insurance Verification Form
Only use this form if your have not contacted my biller and left all ins info with her or in a message
Only complete this form if our sessions are using the computer or phone
Secondary Insurance Form
(only complete this form if you have secondary insurance)
ONLY complete this form if you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.) to authorize a release of your psychotherapy 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.