Intake Paperwork

Save time before our first meeting.   Make it easier to meet with me remotely.  Download and fill out the forms below. Take a photo of the form(s) with your phone and email them back to me.

Working With Your Insurance Company

I am not an "in-network" provider for any insurance company. Depending upon your insurance carrier and coverage, PPO “out-of-network” reimbursement for sessions may be available. Your insurance plan may compensate you in full or in part for your visits to me, depending upon the provisions of your particular plan.


First, you will need to determine what your benefits are. You can find that information yourself, by calling the 1-800 number on the back of your insurance card. These questions will help determine if your insurance plan will compensate you for all or part of your expenses:

  1. Do I have "out of network" mental health insurance benefits?

  2. What is my annual deductible and has it been met?

  3. What month does the coverage end or begin?


You will be responsible for payment at the beginning of each session. I will provide you with a monthly summary of services (“Superbill”) that you can submit to your insurance company. You are responsible for all fees, whether or not insurance reimbursement is available.  I accept cash, check, or credit card payment.


Services provided may also be eligible for tax-free reimbursement under your employer-sponsored flexible spending account (FSA, MSA, or FLEX plan). Check with your company’s human resources manager for more information. In our experience, most HSA credit or debit cards have been accepted through our credit card payment, but this is not guaranteed.