For your convenience, before our first session, please read and complete the New Client Registration Form and Agreement for Services. The Agreement explains my fees, insurance billing, etc.. (Please note that I am an “out of network provider” for insurance plans. Also, remember that you can use your Health Savings or Flexible Savings Account, if applicable.) If you would like me to consult with another professional regarding your care (psychiatrist, primary care provider, another therapist, etc.), please complete the Authorization for Release of Information. Please also complete the Credit Card Authorization if you plan to use your credit card, HSA or FSA for payment.
Please return these forms by mail or electronically, or bring them with you to your appointment. At that time we can also address any questions you may have.
All forms are PDF Format. (Get the free Adobe Reader.)