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Addiction Trauma & Relationship Specialist
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Downloads

Please bring all completed forms (below) to first session. If scheduling a first time appointment via the Simple Practice calendar, appointment will not be confirmed until therapist has received client face-sheet and you receive a confirmation email or call. 

RS_full Intake UPDATED (pdf)Download
RS_Notice PHI (pdf)Download
RS_Disclosure Statement (pdf)Download
RS_Credit Card Auth Form Recurring (pdf)Download
RS_Release of Information 3 (pdf)Download
20203_FInancial Agreement-$165 (docx)Download

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