If you're a new client, please complete the following forms and bring them to your first therapy session.
Agreement And Informed Consent For Treatment.
Client Information Form
- Fee Agreement and Insurance information NOTE: If using insurance, please call them before filling out the Fee Agreement Form. Please ask..
- Do you have a deductible, if so, what amount remains?
- Is there a copay, and if so, for how much?
- Is Preauthorization required and if so by whom?
Authorization to Disclose PHI NOTE: Please do not fill out this form on your own, but bring to office visit
- Professional Service Contract
I now offer Telehealth services. If you're interested, please fill out the form below.
Note: To download Adobe Acrobat Reader for free, click here.