Things to read and fill out before your first visit

Please print out and complete the Health History form found at the bottom of the page. Bring it with you to your first appointment.  Thank you!

Policies: I understand that your time is valuable. Please honor my time as well as that of my other clients by reading and understanding my policies. Exceptions to these policies are not possible. They have been established in an effort to be fair to all my clients.


  • Payment due at time of service.
  • Cash, checks, debit and credit are accepted.
  • Checks returned for insufficient funds or stopped payment will be subject to a $30 fee.
  • I currently do not bill insurance.


  • 24-hour cancellation required. Late cancellations will be charged a fee equal to 1/2 of the full cost of your scheduled session.
  • If you cannot make your appointment send a friend in your place or call to reschedule. 
  • As a courtesy to my next client, sessions cannot be extended if you arrive late. Full fees apply.


Your identity, records and all issues discussed during the course of therapy are strictly confidential in accordance to HIPAA regulations.

Right of Refusal:

I reserve the right to refuse service to anyone. This includes but is not limited to anyone who requests treatment or services that are outside of my scope of practice. Full session fee will be charged whether or not services were rendered.

Health History.pdf30.86 KB