If you are a new client, please complete the appropriate information packet below (adult or child/adolescent) and bring this form to your intake appointment. Please review the other two "client copy" forms and retain a copy for your records. Additional copies are available at your appointment.
If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, previous therapist, etc.), complete this form to authorize release of your protected health information.
If you are a provider, family member, teacher, school counselor/social worker, college counselor, lawyer, or other individual who would like to make a referral for someone, please complete the following form and return it by fax, email, or regular mail (listed at the bottom of this page).
Note: To download Adobe Acrobat Reader for free, click here.