Signup For Therapy
Are you ready to make lasting changes in your life? If so, you need to complete the paperwork to become a Client. Completing the paperwork is easy, as you can complete it all online without printing out forms. To do so, follow the instructions below.
Online Forms
To complete the forms, please visit the link below and create a free account. This account is a part of my content management system and is secured by the latest security standards. This allows you to complete all forms before the session without having to print them out and complete them by hand.
You will first need to create an account. To do so, input your First Name, Last Name, E-Mail Address, and Password. Your password needs to be at least six characters. Once inputted, you can begin to complete the paperwork. Make sure to complete all the forms, sign, and submit them.
Note: Signed Divorce Decree or Signed Adjudicating Parentage Decree (Required if the patient is a minor under 18 with divorced parents. Send to me well before the first session so I can determine if both parents need consent.)
Printable Forms
The following is a list of important client forms. The forms marked as required will need to be completed before I can begin providing psychotherapy services. If you have any questions about the forms, you can Contact me.
Note: Signed Divorce Decree or Signed Adjudicating Parentage Decree (Required if the patient is a minor under 18 with divorced parents. Send to me well before the first session so I can determine if both parents need consent.)
Consent for Services (Required)
New Patient Questionnaire (Required)
New Patient Forms (Required)
Notice of Privacy Practices (Required)
Emergency Information (Required)
Email Consent (Required)
Teletherapy Consent (Required)
Authorization to Release Information Form
Sliding Scale Form
*Note* All forms are in PDF Format. Click Here to view PDF files using Adobe Reader.
I Will Contact You Soon
Thank you for your interest. I will do what I can to help you and your family. Once I receive the paperwork, I usually respond within 24 hours. If you have any questions, please Contact Me!