Counseling and Wellness Suite 203

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

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

Client Psychotherapy Intake Form 
Limits of Confidentiality/Therapy Cancellation Policy 
Authorization to Disclose Information Form 
Maryland Child Abuse Reporting Information 
Insurance Forms 
Sliding Fee Discount Form