Prior to signing this form, please review the Privacy Practices which is posted on this website at the page titled Notice of Privacy

Please, review the "contract/consent" document; it describes the terms of therapy. Please, print out the Signature page (at the end of the document). Please, note that there are two different Signature pages: one - if you are going to pay for therapy out of pocket, and the other - if you are going to use your insurance. Print out the Signature page that applies. If you don't have a printer or do not wish to print, I'll provide you with the forms at the office. Thank you.

Intake Questionnaire (background information, insurance information, etc.). If you are unable to download/open this .doc file, try the Intake Questionnaire file below (in .docx format).

Intake Questionnaire (background information, insurance information, etc.). If you are unable to download/open this .docx file, try the Intake Questionnaire file below (in .doc format). If you are still unable to open/download any of these documents, let me know and I will provide you with a print copy on the day of the initial meeting. Thank you.