Please Complete the following forms prior to your appointment

CITS Intake Packet

(Required) This form will need to be completed prior to your first appointment.  This information helps me understand the challenges you are facing so that a care plan matching your needs, wants, hopes, and desires can be met.

Release of information

Your appointment is confidential and your information will be protected.  Circumstances indicating a release of information are:

• You are requesting that I report any of your protected information to another person, agency, physician, etc.;
• I am billing your insurance carrier;
• ​You want your loved ones involved in sessions or to have contact with me.

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