client forms and information

If you're a new client, please print out a copy of the following two forms, fill them out, sign both of them and bring them to your first therapy session.  (Please note, these forms cannot be filled out on-line.  They must be printed and filled out by hand.)

Intake Form

HPPA Form

Please feel free to make copies of these forms for your own records - or you may return to this site for future reference or clarification at any time.

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If you would like for me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc), .please click on the Medicial Release button below, print a copy of the form and fill it out to authorize release of psychotherapy information.  Scan it and email me a copy or bring it with you to your next session for me to keep on file.

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To view copy of my current professional 

license, click on: 

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