New Client Forms

There is currently a long waitlist for new clients. Please email or call regarding new client availability. If you have an appointment already scheduled and confirmed, please download and fill out the following two forms in advance before your session (if possible). Thank you.

Client Intake Form

Consent to Treatment


The following two forms are for your own use. Please print out our privacy practices at your convenience to have as reference.


Notice of Privacy Practices

Professional Disclosure Statement

To help you answer questions about fees and insurance, please read the following information. I am an in-network provider for most major insurance companies. Before your initial appointment, please call your insurance company to confirm your coverage, copay amount and possible deductible. Please note that some insurance plans will not pay at all until the entire deductible has been met.




You can use the above pdf insurance form to ask your insurance provider about mental health coverage.

If you choose to not use your insurance carrier for counseling services, the full fee rate for counseling without insurance is $120.00 per hour. There are several reasons why people would choose to do this. 


Also, please note that all health care plans are not created equal. It is in your best interest to do your homework prior to any appointments so you do not end up with the bills.


Cash, check and credit card are accepted forms of payment.


Current Accepted Insurances:



Blue Cross Blue Shield

Medical Mutual






OSU Primecare/NGS/Coresource







Out of Network

Self Pay

Value Options/Beacon