Fees & Forms


Fees are outlined in the Policies and Procedures attachment below. Please contact me if you have questions about fees. I am an out of network provider and do not participate with any insurance panels.  Cash, checks, and all major credit cards are accepted. Payment is due in full at time of service.


Please complete the following forms and bring them to your first appointment.

All forms are required except for the Credit Card Authorization form (optional) and the Release of Information form. The release of information form is only necessary if you have a psychiatrist, doctor, school counselor, or other professional you would like your provider to communicate with about your treatment.

If you have any questions about completing the forms, please feel free to contact me.

Click to download: