If you're a new client, please complete the following forms and bring them to your first therapy session.
- LCC Intake Form Adults Clients_416.doc
- LCC Intake Form Minors 416.doc
- NEW ADULT CLIENT INTAKE FORM.doc
- Telemental Health Consent Form
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:
Note: To download Adobe Acrobat Reader for free, click here .
We are committed to your privacy.
Do not include confidential or private information regarding your health
condition in this form or any other form found on this website.
This form is for general questions or messages to the practitioner.
We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.