(808) 226-9442 [email protected]
 

* Unable to take new patients at this time.

The following forms will need to be completed before scheduling your first session.  Please do not complete these forms until you’ve been accepted as a new patient.  Each session is typically 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.

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 [email protected].

Would you like to…?

Use the Divi Builder…

to design your pop-up!

Donec rutrum congue leo eget malesuada. Curabitur non nulla sit amet nisl tempus convallis quis ac lectus. Cras ultricies ligula sed magna dictum porta. Curabitur aliquet quam id dui posuere blandit. Proin eget tortor risus.