Intake Form

Personal History, Issues and Objectives
To help you get started as efficiently as possible, I've placed a Personal History Form on this site that you can use to provide the basic information we need to begin therapy. If you print out and complete this form before your first visit, we can get started more quickly.

This form lets you provide a concise description of your background and family, any previous experience with therapy and issues you would like to address.

Working Together

To help prepare for therapy and to understand how we will work together, you may want to look at the following document that is the Consent for Therapy I ask each client to review and sign. It provides an overview of my practice; a description of the benefits and risks of treatment; office policies; confidentiality and limits to confidentiality; and how to address complaints.
You can use these links to jump to any part of the Consent for Therapy:
   Clinical Overview
   Benefits and Risks of Treatment, Office Policies
   Confidentiality and Limits to Confidentiality, Complaints

A print-friendly version of this document is available in Adobe Acrobat PDF format, here.

Consent for Therapy

This Consent for Therapy is to inform you of the risks as well as the potential benefits of outpatient therapy.

The modalities of outpatient psychotherapy utilized in my office are widely accepted forms of psychological treatment. As with all forms of clinical treatment, there are risks to be considered in the process of making an informed decision to seek treatment.

This Consent also defines my office policies and procedures relating to appointments and payment for services.
As a client, you have rights to confidentiality. This Consent describes the policy I follow to protect those rights and specific circumstances when therapists are require by law, to disclose patient information.

Clinical Overview

My practice includes individual, couples and group therapy. I am a Licensed Clinical Social Worker (LCSW). I am also a Licensed Marriage + Family Therapist (LMFT) and a Licensed Chemical Dependency Counselor (LCDC). I am a Certified Sex Addiction Therapist (CSAT). I utilize and am certified in Imago Relationship Therapy, Voice Dialogue, and EMDR.
My treatment approach is based upon each client’s specific clinical needs as identified during the initial session(s).The client’s therapy options are then discussed and a plan for treatment is determined. A client’s needs sometimes change over the course of their outpatient therapy, which may necessitate a reevaluation of their treatment plan. When this occurs, treatment options are once again discussed and determined by the client and therapist. If, at any time, the client and/or therapist believe the client’s clinical issues require alternative or additional resources, every effort will be made to assist the client in locating these resources.

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