Documents

Please access the documents below, as needed. If you are a new client, please read through all applicable documents.

Introductory Letter

This is my Introductory Letter to all New Clients. If you are a new client, please read through this information to get a better idea of my approach and what services I may be able to offer you.

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New Client Intake Form

For new clients: To expedite our time together, please download and complete this form and bring it with you to your first appointment.

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Sliding Fee Scale

I am willing to negotiate a fee-for-service on a sliding scale basis. Recommended fee amounts are based on earnings. 

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Consent for Purposes of Treatment, Payment & Healthcare Operations

For new clients: To expedite our time together, please download and complete this form and bring it with you to your first appointment.

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Office Policies and Informed Consent Form

For new clients: To expedite our time together, please download and complete this form and bring it with you to your first appointment.

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HIPAA Notice of Privacy Practices

This notice describes how medical information about you may be used and disclosed and how you can get access to this information.

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Release of Information

Please print and complete this form if you would like to give me permission to share your information with a specified health care provider.

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