If you are a new client or a returning client that has been inactive for 2 months/60 days or longer, please complete the following forms and email them to [email protected] (this email is secure and HIPAA compliant) prior to your initial therapy session. You may also contact me at (904) 716-3828 to discuss any questions you may have regarding any form found below.
For a list of accepted insurances accepted, Click Here
To verify insurance is active, include this form along with the Consent Form Insurance Verification Form
Adolescent
- Adolescent Consent Form Packet
Adult
- Adult Consent Form Packet
ADDITIONAL DOCUMENTS
- If you would like me to coordinate care with another individual (example: psychiatrist, primary care physician, family member, etc...), print and complete this form, scan and email back to me at [email protected] or bring with you to your next scheduled session in order to authorize releasing partial or your complete medical record information: Release of Information