To apply for the Sliding Fee Discount click here.  

 

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

 

• Client Psychotherapy Intake Form 

• Informed Consent/ Limits of Confidentiality/HIPAA

• Consumer Rights

 

If you would like me to coordinate care with another provider, such as your psychiatrist or family physician, school, department of juvenile justice or the local department of social services, 

please complete the following form to authorize the release of your therapy information:

 

• Authorization to Disclose Information Form

 

If you are a provider and wish to make a referral for someone for services, please complete the attached form:

 

• Referral Form

 

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