Helpful Forms

If you’re a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Medicare allows reimbursement to the patient directly for money spent to pay for out-of-network medical providers. Once I give you a receipt that will have the appropriate medical and treatment codes, you can attach it to this medicare form to request reimbursement from Medicare and your secondary insurance. I do not know the exact amounts you will be reimbursed but clients tell me it is significant.

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