The following forms will need to be completed before scheduling your first session. Each session is typically 45-50 minutes.
PLEASE NOTE I do not accept any cases that have active court involvement (i.e. Child Welfare, Divorce/Custody, Criminal).
If the primary patient is a minor (under age 18), please also complete the child/adolescent intake information form. For minors in counseling, the legal parent or guardian must sign the consent forms. For shared custody, both parents must sign the consent forms.
- Client Registration Form Fillable
- Informed Consent Fillable
- HIPAA Policies
- Credit Card Auth Form
- (Adults Only) Adult Intake Information
- (Minors Only) Child Adolescent Intake Information
If you plan to utilize your insurance, please attach:
- A photo of your medical insurance card
- A photo of your picture ID (Driver’s License, State ID, Etc.)
Please indicate to me via email if you are preferring in-person or telehealth sessions.
Once completed, please email the completed forms and items to firstname.lastname@example.org.