Helpful Forms

If you're a new client, please complete the following form and bring them to your first therapy session.You will also need a copy of your insurance card and your primary care physician's name, address, phone number, and fax number. It always helps the process if you have already discussed with your doctor that you will be seeking counseling services with us. Otherwise, they may not authorize the use of your insurance policy to pay for services rendered.

userfiles/3642617/file/Referral form.pdf

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:

userfiles/3642617/file/Authorization form.pdf

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HELPFUL FORMS

Click here to view and print forms for your appointment.

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