Helpful Forms

• If you're a first-time client, please review and complete the following forms, bring them to your first session.

• Client Intake Form

• Limits of Confidentiality/Cancellation Policy Form

If you would like me to coordinate care with another provider (for example, your psychiatrist, endocrinologist, etc.), complete this form:

• Consent to Release Information Form

• Please insert your Insurance information at the top of the intake form.
• Name of Insurance Co. and Id #.

Client Intake Form

Confidentiality and Cancellation Policy

Consent to Release

Note: To download Adobe Acrobat Reader for free, click here .



We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.