New Patient Forms

For your convenience, I offer my new patient forms online. You can save time at your first appointment by downloading, printing, and completing the forms before your first visit. Please bring these forms to your first appointment.

This download contains multiple forms for a total of 5 pages.

Insurance

I accept several insurances.  Please check with your insurance carrier to find out if your insurance covers Mental Health Benefits and that I am an in-network provider.  Some insurances require preauthorization.  This can be obtained through a phone call to your insurance company.  Many insurances have a co-pay.  I accept cash and checks.

Release of Information Form

To protect your privacy, information can be shared with someone else only with your permission.

For examples you might want me to share private information with other professionals including physicians, teachers, referral source(s), allied therapists, and attorneys. For patients over the age of 18, I can share information with your parents with your written permission. In other cases, you may want me to review information from physicians or past therapists.

Sharing information is completely voluntary.

To allow or request information to be shared between me and someone else, please download and complete the form by clicking on the button below.  This form can be submitted to me by mail or in person.