Please either fill out the necessary forms and submit online or print out and complete the "Client Intake Form" as well as the "Confidentiality and Cancellation Policy Form" and bring them to your first appointment, or allow yourself 15 minutes prior to your appointment to complete the forms in the office. For couples, please also fill out the "Couples Intake Form." For children under the age of 18, please have a parent or guardian fill out the "Minors Intake Form" as well as the "Consent to Treat A Minor Form." The information you provide here is held to the same standards of confidentiality as our therapy.
Confidentiality Online Form | PDFCancellation Policy Online Form | PDF
Telehealth Authorization Online Form | PDF
Client Intake Form Online Form | PDF
Couples Intake Form Online Form | PDF
Minors Intake Form Online Form | PDF
Consent To Treat A Minor Online Form | PDF
If you would like me to coordinate care with another provider (for example: your psychiatrist or primary care physician) please fill out and submit online or print out and complete the "Authorization Form" in order to authorize release of psychotherapy information.
Authorization Form Online Form | PDFKP Authorization Form Online Form | PDF
Insurance
I accept most PPO insurance programs as an out-of-network provider. Services may be covered in part or full, by your health insurance or employee benefit plan. Please contact me so that I may determine if this is a viable option for you. I accept the following insurance companies:
• Aetna
• Anthem Blue Cross
• Health Net / MHN
• Kaiser Permanente
• United Health Care / OPTUM
Rates
My fees for services are:
• $150 for Individual therapy
• $175 for Couple therapy
• $200 for Family therapy
Please contact me to discuss availability of sliding scale.
Payment
Cash, Venmo, Zelle and major Credit Cards are accepted. Payment must be made prior to start of each session.
Cancellation Policy
I require a 24-hour cancellation notice. If you cancel your appointment with less than 24 hours notice, you will be charged in full for the session.
Contact
Questions? Please contact me for further information.