Forms for New Clients

Please complete the intake and forms linked below. Please email me the completed intake form at least 2 business days before our first scheduled appointment.
Please bring the other completed forms to our first meeting.

Please allow 1.5 -2 hours for our first meetings
Subsequent therapy sessions are 1 hour
(We can schedule longer sessions as needed)

 

I have a 24-hour cancellation policy

Please provide at least 24- hours’ notice to reschedule an appointment. If you must reschedule a Monday appointment, please contact me by 5p on the preceding Friday.

Insurance does not pay for late cancellations or missed appointments.

Insured clients are charged $75 for missed initial evaluations or those canceled with less than 24-hours’ notice and $50 for missed one hour therapy sessions or those canceled with less than 24-hours’ notice

Self-pay clients are charged $100 for missed initial evaluations or those canceled with less than 24-hours’ notice and our agreed upon hourly rate for missed one hour therapy sessions or those canceled with less than 24-hours’ notice.

Click the links to download the forms

pdf

Fee Agreement

Please enter your co-pay or the session fee we agreed upon
pdf

Privacy Practices HIPAA Information

Please return only the signature page
pdf

Release of Information

Please complete this if you’d like me to speak with your attorney, physician, previous therapist (or anyone else)

Please remember to scan and email me the completed intake form at least 48 business hours before our first appointment and bring the other completed forms when we meet.

Email: [email protected]

Please feel free to contact me with any questions about these forms or
anything else.  Ethical and legal guidelines prohibit me from
meeting with new clients without these completed forms. 
Thank you for your cooperation.