New Patient Forms

Interested in becoming a patient? Please complete the following form before your first visit:


Session Fees:

  • Individual sessions (50 minutes) $175
  • Couples sessions (50 minutes) $175

* I do reserve several sliding scale spaces, please inquire if needed.

Do you accept insurance?

I do not deal directly with any insurance companies but my services are reimbursable for out-of-network benefits by most insurance plans.  Some questions for your insurance company:

  • Do I have behavioral health benefits?
  • Is there a deductible? How much is it and has it been met?
  • How many sessions per calendar year does my plan cover?
  • Is approval required by my primary doctor?

If requested, I will gladly generate an invoice for you to file claims with your carrier.

What is your cancellation policy?

24 hours notice is required for cancelled or rescheduled appointments. There is a $50 fee for appointments that are not cancelled 24 hours in advance.  Of course, emergencies and illness are considered.

What forms of payment do you accept?

I accept cash, checks, Visa and Mastercard.  Payment for individual and couple sessions is due at the time of service.

What about confidentiality?

The relationship between therapist and client is protected by law and information cannot be disclosed without written consent.  The only exceptions are if and when there is suspected child abuse/neglect or when the client threatens serious harm to self or others, in which case every effort is made to ensure the safety of those affected as required by law.