Not Accepting New Patients

Client Forms

Client Forms

If we have agreed to work with each other, please fill out these forms before your first session with me. Either bring them to your first session (if we are meeting in person) or scan and send them to me via email at, before your first Virtual Therapy Session. Thanks!

Patient Information Form

Professional Service Agreement

Insurance Information Needed

Release of Information to Insurance Companies

Cancellation/Missed Appointment Policy

Zoom Teletherapy Consent Form

Massachusetts Notice Form

Patient’s Acknowledgement of Receipt of Privacy Notice

Medicare Private Contract Form

If you would like me to either talk to a previous therapist or for me to collaborate with one of the other therapists or prescribers you are currently seeing, please fill out this form.

Authorization for Request/Release of Information Form

Good Faith Estimate