Client Forms
Please download and complete the necessary forms before your visit. If you have any questions please visit our contact page or your client portal.
Child Intake
Adult Intake
Authorization for Release for Insurance Company
Authorization of Release for Primary Care Doctor
Disclosure Statement
Financial Responsibility
HIPPA Addendum
HIPPA Client Rights
Credit Card Data Insured Responsibility
You’re Not Alone. And I’m Here to Help!
With more than 20+ years of navigating my own transformation through life’s storms, hills, & valleys from childhood trauma & addiction, to the effects mental illness, to overcoming it and living well! My mental health and addiction clients feel stuck & desire empathetic, judgement-free support from someone whose walked in their shoes and succeeded.
Get started with a FREE phone consultation now.