If you're a new client, please complete the following forms and bring them to your first therapy session.
Please fill out the following sliding fee evaluation form and return either by fax to (866) 824-9980 or email to [email protected]
Your application will be reviewed to determine the sliding fee for the initial intake and the subsequent therapy sessions. The Sliding Fee Agreement will be signed at your first meeting.
Thank you for considering our services.
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:
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