Intake Forms

There are several forms that a new patient will need to complete to help me assess your needs and save valuable therapy time. You can securely fill these forms out here online and they will be sent to me by encrypted email. The Intake Form will allow you to save where you are if you are unable to complete the form in one sitting. We require a login and password which gives additional privacy and help us further protect your health information.

I am bound by HIPPA laws to guard your privacy. I will delete your data immediately if you choose to not begin therapy with me or end it in the future.

The following form will allow you to register. Once you have registered you will see additional menu items with the intake forms.

PLEASE NOTE:  If you hit submit on one of the forms and nothing seems to happen, that generally means there is a required field that needs to be completed. It will take you to the top of the screen and display, “There was a problem with your submission. Errors have been highlighted below.” If you scroll down you will see those fields are clearly marked in red.

Please don’t hesitate to call or email me if you have any questions about these forms or your privacy.



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