Below are forms you may download and fill out to save you time at the office.
Client Intake Form
Please fill out this biographical background form as completely as possible. It will help me in our work together. Information is confidential as outlined in the Agreement of Psychotherapy Form and the HIPPA Notice of Privacy Practices. If you do not desire to answer any questions, please write “N/A.” Please print or write clearly and bring this form with you to your first session.
THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE
USED AND DISCLOSED AND HOW YOU CAN GET ACCESS TO THIS
1462 U.S. 395 (North)
Gardnerville, NV 89410
NV License: PY0674
Request More Information
Have a question about any of the services I offer? Ready to schedule an appointment? Please fill out the form below. By providing me with the information requested, I will be able to get an idea of how I can best support you in your therapeutic journey. Because I respect your privacy, all information provided will be kept confidential and your e-mail address will ONLY be used to reply back to your request, if needed. Thank you!