Forms

Please complete all forms found on this page and email them to me by hitting reply to the initial email I send after our phone consultation. This will be the best method to ensure your privacy and confidentiality—by returning the forms via the encrypted email established initially.

If you have saved the forms to the hard drive of your computer, it is advised to delete them so that other people who use your computer are not able to view your confidential information.

You may also wish to use https://smallpdf.com/sign-pdf to eSign the forms. It is advised to sign the forms prior to inputting the data so that your information is not collected on this website.

Intake Forms (Adult and Child)

Notice and Receipt of Privacy Practices / Medicare Opt Out Form

Authorization for Electronic Communication / Electronic Payment Communications and Electronic Health Records Disclosure

Client Information Sheet / Information Release

Financial Agreement / Confidentiality, Policies and Consent