Switch to Accessible Site
Couple by a Lake
Couple by a Lake

Client Paperwork & Referral Form

If you are a new client and have scheduled an appointment with me, please complete the appropriate information packet below (adult or child/adolescent) prior to the intake session. You can either send the completed form to me by regular mail or email and it must be received by the evening before 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.

Schedule Appointment

Start your new path in life and be the change today!

Click Here
Helpful Forms

Click here to view and print forms for your appointment.

Click Here