Helpful Forms

If you are a new client and would like to see if your insurance is accepted by the provider or to get an appointment as an out of network/private pay patient, please click on this link to a HIPAA secure web form. You will be taken to a separate web page. Please complete the form and you will then receive an email confirmation of benefits and financial responsibility.

• Patient Information and Financial Agreement (HIPAA Secure)

If you are not using insurance and will be a private pay client, please complete this form and bring it to your first therapy session.

• Patient Demographic and Contact Info Form

If you're a new client, please complete the following forms and bring them to your first therapy session.

• OFFICE POLICIES AND GENERAL INFORMATION AGREEMENT FOR SERVICES

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

• Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here .