Helpful Forms

Let’s help you get started on your new path to well-being by preparing for your first session.

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

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:

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

Make an Appointment

To schedule an individual, children, couples, marriage or family therapy appointment or to obtain additional information about any of these counseling services, please fill out the form below or give us a call at (267) 225-7402.

We are committed to your privacy. This form is for general questions or messages to the practitioner. This form is for general questions or messages to the practitioner.

Preferred Location

Session Requested

By clicking send you agree that the phone number you provided may be used to contact you (including autodialed or pre-recorded calls). Consent is not a condition of purchase.