If you're a new patient, please complete the following forms and bring them to your first therapy session.
- Patient Psychotherapy Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
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
|Patient Psychotherapy Intake Form|
|Limits of Confidentiality/Therapy Cancellation Policy|
|Authorization to Disclose Information Form|
|No Surprises Act|
Note: To download Adobe Acrobat Reader for free, click here .
Please feel free to contact me by completing the form below:
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.