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TransformationStarts With You
Woman Being Free

Helpful Forms

If you're a first-time client, please review and complete the following forms, bring them to your first session.

Consent to treat Form
HIPAA Notice of Privacy Practices Form
Consent for Psychotherapy Form
Consent to Treat Minor Form


Adult Intake Form
Child / Adolescent History - Parent Form

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

Protected Health Information Release Authorization

 

 

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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.

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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.

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Helpful Forms

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