Please click on New Client Forms below to print intake forms. You will need to print and complete these forms manually, unless you have autofill software. All forms must be completed, signed, and returned to me before an appointment will be scheduled. Forms can either be scanned and emailed back to me at firstname.lastname@example.org, or faxed to 844-463-4089. If you prefer, sensitive information (ie., social security #, credit card info, etc.) can be completed by phone.
I am required by law to provide you with the Notice of Privacy Practices, which you can review by clicking the second button below. You will consent to reading and receiving it on the intake forms (New Client Forms, 1st button below).