Forms

Welcome! I'm looking forward to working together. Please complete the forms below and send them to me via Spruce (learn more below) at least 24hrs. prior to your appointment time. These forms provide me with important information needed to tailor a treatment plan for your unique goals and outlines the expectations of client and therapist as we begin our work together.

Please note: for legal and ethical reasons, I am unable to begin our session until I have received your completed paperwork.

Before Your First Appointment

New Client Forms Packet — all of the intake forms combined into one document for your convenience. For relationship/family therapy, please have each client fill out a packet.

Additional Forms (as needed)

I may ask you to fill out these additional forms based on your unique needs.

ART and EMDR Informed Consent and Agreement — If we are using ART (Accelerated Resolution Therapy) or EMDR (Eye Movement Desensitization and Reprocessing), please complete and return this form.

Medicare Private Pay (Opt Out) Contract — If you have Medicare, please complete this form to confirm your consent to use private pay therapy.

Reduced Fee Agreement — This form is for clients requesting a reduced fee based on need.

Release of Information Consent Form — I may ask you to fill out this form to collaborate with your other health providers in order to improve your treatment.

Updated Client Contact Information Form — If your contact information (or your emergency contact information) changes during the course of our work together, please complete and return this form.

Clients—Connect with me via

To enhance security and client privacy, I use the HIPAA-compliant platform Spruce, where we can securely exchange messages, photos, and documents. Available free to clients via mobile app, desktop app, and web browser.

My Spruce Link

Learn More