Please complete the following forms and bring them to your first therapy session.
|Client Psychotherapy Intake Form|
|Limits of Confidentiality/Therapy Cancellation Policy|
|Long Intake Form||
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.
Authorization to Disclose Information Form
For Hypnosis Clients please read and sign
Hypnosis Consent Form
For 65 year olds clients and older to print out, sign, date and submit with their PPO Insurance request (Medicare)
Medicare Opt-out Letter for Clients
Medicare/Medicaid Opt-Out Affidavit
Medicare Opt-out Letter
Medicare Opt-out Affidavit
Note: To download Adobe Acrobat Reader for free, click here.