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


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.

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.

To view copy of my current professional 

license, click on: