Client Forms

For your convenience, the following forms are provided here for you. Please follow the instructions listed after each form. If you will be doing distance therapy, please complete and sign the appropriate forms (for Disclosure Statement, you want the one entitled, “Disclosure Statement for Distance Therapy) and either scan/email them to me (

Prior to your first session, please watch the video at the bottom so you know what to expect

For Everyone:

In addition to the above forms, please add the following based on your payment method.

Self Pay:

  • Fee Policy (print off 2 copies of this and bring to 1st session)


Insurance (I’m currently an in-network provider for Aetna, Anthem/Blue Cross Blue Shield and Cigna):

First Session: What to Expect

Helping You on the Path From Surviving to Thriving