Switch to Accessible Site

"Tell me, what is it you plan to do with your one wild and precious life?"

                                                                       ---Mary Oliver 

 

 

 

 

Woman Standing on Dock
Woman Standing on Docks

Intake Forms

 

If you're a new client, please download and complete the following forms to bring along to our first appointment.  (If you do not have access to a printer then please let me know and I will mail these to you.)  Note that if we are doing teletherapy, I'll need the forms mailed to my office or scanned and sent as attachments to email (you may wish to password protect and send me the password separately).  

 

 

If you are an Anthem BC/BS insured, please complete this additional form and also bring your health insurance card to the first session.  (This form looks intrusive but all I need is your written permission to file claims for you. Typically this means you check off "only limited information" and then in the next text box: benefits & coverage; billing; claims & payments; diagnosis & procedure; behavioral health.)

 

If you have any other type of health insurance policy that you wish to use, just bring your insurance card with you to the first session.

 

 

Note: To download Adobe Acrobat Reader for free, click here.

Helpful Forms

Click here to view and print forms for your appointment.

CLICK HERE