Forms · Financials · Links
New clients, please be sure to complete and print out all required forms prior to your first visit.
Please note that there are forms that need to be completed prior to your first session. Copies of these forms are kept at my office, if you do not have access to a computer or a printer. Also, please understand that there may be other documentation required on a case-by-case basis.
The following forms (Patient Information, HIPAA Notice of Privacy Practice, Contract for Therapeutic Services) should be completed prior to the first therapy session by all parties, regardless of age.
The Developmental History Questionnaire is specifically for clients who are under age 18.
The Referral Form can be filled out at the beginning of our therapeutic association in case you wish me to communicate with other Health Professionals.
HIPAA Notice of Privacy Practice
Contract for Therapeutic Services
Developmental History Questionnaire
The following form is voluntary, to be used for ease of payment.
Credit Card Authorization for Payment
I accept all major credit cards, checks, Venmo (preferred method in this time of online therapy) and, of course, cash. My standard fee is $150.00 for 45 minutes. As many mental health providers, I do offer a sliding fee scale, discussed by the therapist and the client in the beginning of the therapeutic process. If applicable, there will be a $35 returned check fee.
I currently do not accept insurance, and have no plans to join insurance panels at this time.
Finally, if you must cancel your appointment, please do so prior to 24 hours, as anything less than a 24 hour notice will incur payment of fees. Additionally, if you “no show” to your appointment, you will also incur payment of fees. After three “no shows” I may remove you from the schedule.
National Alliance on Mental Illness (NAMI)
Substance Abuse and Mental Health Services Administration (SAMHSA)