Helpful Forms

If you're a new client, please choose and complete the appropriate intake form as well as print and sign the Informed Consent. Please bring these forms with you to your first appointment.

Intake Form

Couples' Intake ( This form must be filled out separately by each partner )

Professional Disclosure Statement

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 .

 Contact Info

Email: [email protected]
Phone: 910-636-5100