There are three form packets for you to choose from. Click to download the packet that applies to you.
Please download, print and complete all the applicable forms in your packet and bring them to your first appointment.
Couple, Family or Individual Intake Form: Asks for your contact information and other basic information about you relevant to your treatment.
Informed Consent: Informs you of your rights and responsibilities as a client and also contains important information about my practice. PLEASE READ THIS FORM CAREFULLY!
HIPAA: Just like the form you fill out when you go to the doctor or dentist, this form conveys the privacy practices that are in place in my psychotherapy practice as a marriage and family therapist to ensure that your health information is protected.
Release of Information: Gives me legal permission to share information related to your therapy with any other providers involved in your mental health care in order to coordinate treatment.
If you are seeking therapy for couples or family therapy, please note that all members of your couple or family are required to sign the forms. I only need one copy of each form for all members.
As of May 1st 2017, my rate is $200 per hour. I accept Visa, MasterCard, American Express, Discover, JCB, and UnionPay. I don't work with insurance companies directly, but I can provide you with a statement of payment. Many of my clients have used this to get reimbursement from their insurance companies for some or all of the cost of couples therapy services with me. Please check with your insurance company to find out about the specifics of your policy and I will be happy to work with you to make this process as convenient as possible.
Regardless of whether you would like to book an appointment for couples counseling, family counseling, or individual counseling, an initial 10-15 minute phone call is required at no charge. This call will give me the opportunity to find out what your goals are for therapy and ensure that my services will be a good fit for you.
The first session must be scheduled for three hours. Subsequent couples therapy sessions (if needed) are usually two hours in length until it is appropriate to reduce the session length to one hour.
If you would like to find out more about my orientation to couples counseling, I refer you to the book Wired for Love by Dr. Stan Tatkin.
Both partners are required to attend all couples therapy sessions.
Therapy intensives for relationship problems can be very useful in certain cases but should not be viewed as a replacement for ongoing couples therapy. When a couple intensive is sought, a variety of scheduling options are possible. For instance, 3 to 4 consecutive days with 3 to 4 hours of therapy per day. Please call if you are interested in a couples therapy weekend intensive.
If you are coming from out-of-town, I will ensure that I make an appropriate referral for a marriage and family therapist in your home town to ensure continuity of care after the intensive.
The first family counseling session must be scheduled for two hours.
The first session should be at least 90 minutes in length, after which sessions may be between 60 and 90 minutes.