Specializing in Trauma, Couples, Family Issues

EMDR ~ Lifespan Integration

Forms and Payment


To get to know you better, there is some paperwork I'd like you to fill out before your first session.  You may download the forms from this website by clicking on the links.

Read and save the Welcome Document, Informed Consent, and Privacy Notice.  Please print and sign the privacy notice.

Print, complete, and bring the Information Requested History Questionnaire , and Patient Informationdocuments to our first meeting. 

In order to read and print these documents you'll need a pdf reader.  I recommend Foxit Reader for its small size and fast loading, but Adobe Reader works as well.  If you own a Mac, the document will open in Preview.


I accept all credit cards in my office or through Paypal, as well as checks and cash.  Please click on the link below to go directly to the payment site. 

Click on this LINK to pay with Credit Card through Paypal.


I am not a provider with any insurance companies at this time.

If you do decide you'd like to use your insurance some insurance companies (please check with them beforehand) will reimburse expenses paid to "out-of-network" providers--which is what I am.  I can provide you with an "official" insurance form called a HCFA which will include a diagnostic code, length and dates of visits, and amounts paid.  My clients have had good responses from most insurance companies.