Welcome to my practice!

Please take a moment to view the forms corresponding to your type of service. These forms are required for insurance billing and HIPAA-compliant records keeping.

All documents can either be filled out electronically and sent via email or printed and brought in if you are engaging in face-to-face therapy.

All forms must be completed prior to receiving any services.


** Starting January 1, 2022, consumers now have new billing protections when getting emergency care, non-emergency care from out-of-network providers at in-network facilities, and air ambulance services from out-of-network providers. The Consolidated Appropriations Act of 2021 was enacted on December 27, 2020 and contains many provisions to help protect consumers from surprise bills starting in 2022, including the No Surprises Act under title I and Transparency under title II.
Learn more about protections for consumers, understanding costs in advance to avoid surprise bills, and what happens when payment disagreements arise after receiving medical care. https://www.cms.gov/nosurprises/consumers 
This practice is adhering to No Surprises Act. All self-pay and uninsured clients will be provided with a Good Faith Estimate, outlining estimated costs of services prior to starting psychotherapy sessions.


Adult Psychotherapy


Adolescent Psychotherapy


Telehealth Consent


Privacy Summary


MARI / Personal Development

*** Please note that the latest version of Adobe Reader is required in order to save and email the forms, you may download the newest version here. However, fill in and print feature is available with the older Adobe Reader versions.