Disclosure Statement & Forms

If we decide to set up an appointment, it would be helpful if you could download my Disclosure Statement, which will give you detailed information about my training, approach, and policies, and which you must read and sign before I can legally provide services to you.

Additionally, please download the appropriate intake form (below) and complete it before our first appointment. Please give yourself ample time to do so. The Couple Intake Form should be filled out by each partner individually.

Individual Intake Form (PDF) (4 pages)
Couple Intake Form (PDF) (14 pages)

Finally, please sign my HIPAA Form.

For your information, here is my Notice of Privacy Practices.

In the case that the forms are not accessible to you due to disability, I will be happy to gather the information from you verbally at the time of our meeting.