Forms and Payment

To the right you will find a variety of forms for download.

New clients please download these forms, look over, and we will review them at our first consultation meeting. Please fill out the New Client Profile and Personal Profile ONLY and bring it to your first session.

These forms require Adobe Acrobat Reader which may be downloaded free at the following link:


What To Expect

Each counseling session will be 45 minutes in length with the exception of the first session.  Expect the first session to be a bit longer as we sign forms, and discuss your counseling goals. Remember, I will be meeting you for the first time, so it will take  time to get to know you and the circumstance that brought you in.

Payment Policies

 • My session fees are based on individual situations.  Please call me to discuss options.

 • Payment is due when services are rendered unless other arrangements have been made prior.

 • I am classified as an out of network provider on most insurances. It is your responsibility to pay for services and then you file with your insurance company. I will provide you with the necessary paperwork for reimbursement. Please check with your individual insurance company for verification of coverage and any limitations.

 • I accept cash, check, credit cards (via PayPal). Payment plans available. Please inquire for specifics. To pay via PayPal click the link to the right.

Missed Appointments / Cancellations

Cancellations require 24 hours notice, or you will be billed the full session fee. I reserve a specific time to meet with you, so please call for cancellations or changes. Missed appointments will be billed at full session fee.

 

Forms

click to download

Policies/Informed Consent Form

New Client Profile

Personal Profile

Consent for Treatment

Release of Information

Privacy Policies


If you are having problems downloading these forms please let us know.

Real Women, Real World