MENTAL HEALTH, MARRIAGE/COUPLES and ADDICTIONS COUNSELING.
SERVING CHILDREN, ADOLESCENTS, ADULTS AND FAMILIES

Helpful Forms

If you are a new or returning client, please complete the following forms and bring them to your first therapy session.

  • Intake Form- Please fill out the appropriate form ie. Adult, Adolescent, Couples or Child Intake Form.
  • Insurance Form This forms can be emailed ( [email protected] ) or faxed (907-247-5001) before your therapy session, so that I can inform you of any out of pocket expenses.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

  • Authorization to Disclose Information Form
Couples Enrollment
Insurance Form
Adult Intake Form
Adolescent Intake Form
Child Intake Form
Authorization to Disclose Information Form

Note: To download Adobe Acrobat Reader for free, click here .

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Helpful Forms

Click here to view and print forms for your appointment.

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