Forms

FORMS

Please print and complete each of these forms before your first appointment. Bring the completed forms to your first visit with me. This information will help me to get to know you better and provide the required insurance paperwork needed for reimbursement.

I accept most major insurance plans, credit cards, check and cash. Payment is due at the time of your appointment.

Client Intake Form (pdf)

Download

Informed Consent Form (pdf)

Download

Notice of Privacy Practices (HIPAA) Form (pdf)

Download

Notice of Privacy Practices Receipt (pdf)

Download

Anxiety screening (pdf)

Download

Depression screening (pdf)