Forms and Rate

Please complete these forms and bring them to your first appointment.

Intake Form

Disclosure Statement

Release of Information (Complete only if you’d like to authorize me to talk with someone. For example, a psychiatrist, doctor, previous therapist, or family member.)

My rate is $110 for a 50-minute session. I don’t take insurance, but can provide you with monthly statements to submit to your insurance, if applicable, for out-of-network reimbursement.