Intake forms

All clients will need to complete the following two forms:

Office agreement: Print name, sign, and date.

Credit Card info: If you have insurance with a high-deductible plan, insurance with co-pay, or are a Private Pay client and wish to pay with credit card, please complete the credit card information [Venmo and PayPal also accepted].

New Client form:  Complete all information. If you feel like only highlighting with main bullet points that is fine.  Providing more detail allows the first session to be more open. 

NOTE: FORMS ARE PRIVATE AND SECURE VIA WIX HIPAA PROTOCOL USING HIPAATIZER FORMS.