Mental Health and Addiction Counseling Services

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New client forms

Please print out the entire form, read, complete and bring with you. If you have any questions, please feel free to ask them at your appointment. If you’re coming in for your child please also complete the parental privacy document. You can also choose to come in early and complete the forms while you wait. Thank you.

Release of Information 1 17 17

Patient Intake Form

Parent Agreement of Privacy

Notice of Privacy Practices

Electronic Communication Social Media Agreement

Consent To Treat

Client Info and Insurance

Office Hours

Monday 9:00 - 7:00 pm
Tuesday 9:00 - 4:00 pm
Wednesday 9:00 - 7:00 pm
Thursday 9:00 - 4:00 pm
Fridays 9:00-2:00 pm
Saturdays by appointment.

How can I help you?

By checking this box I acknowledge I have read the privacy disclaimer on bottom of each page on this website

We recommend not including confidential information in your email to protect your privacy; however, if you choose do contact me in this fashion please note that you are giving me permission to respond in kind. This includes the utilization of email contact via this website form or otherwise.