New Client Forms
Welcome new clients!
I’m so glad you’ve decided to take the first step towards the life and relationships you’ve always wanted. Let’s work together to discover how I can best help you.
Client Forms
New client forms are designed to help me get to know you, so that our time together can be as productive as possible. All information you provide is confidential.
If you get stuck or have any questions at all, please contact me.
Click the button below to access all client forms via Hushmail
I will send you an invitation and instructions on how to join Hushmail, which is a HIPAA compliant secure email, so your documents are safe.
Click on each document, review, then sign each document.
Return all documents back to me via Hushmail.
Keep a copy for your records.
Please send me all of your documents two days before our first meeting, so that I have time to review all your documents.
Notice of “good faith estimate” for cash pay and out-of-network clients:
In compliance with the No Surprises Act that went into effect January 1, 2022, under Section 2799B-6 of the Public Health Service Act, all healthcare providers are required to notify clients of their Federal rights and protections against potential “surprise billing.”
This Act requires that we notify you of your federally protected rights to receive a notification when services are rendered by an out-of-network provider, if a client is uninsured, or if a client elects not to use their insurance.
Additionally, we are required to provide you with a Good Faith Estimate of the cost of services. It is difficult to determine the true length of treatment for mental health care and each client has a right to decide how long they would like to participate in psychotherapy services. Therefore, on the Good Faith Estimate form you will find a fee schedule for the services offered by your therapist. I will collaborate with you to determine how many sessions you may need.
Please review the Good Faith Estimate I will send you, and let me know if you have any questions.
For questions or more information about your right to a Good Faith Estimate, visit www.cms.gov/nosurprises.
