Appointments

Current Clients

Follow the link below to schedule a new appointment

New Clients

Please select the appropriate form for your inquiry and respond to the questions to see if I might be a good fit for your journey!

After submitting the form, you will receive an email to complete the intake process and obtain access to my calendar for scheduling.

Name

Phone Number

Email

What Insurance will you be using? I accept Aetna, Premera Blue Cross, Regence Blue Shield and United. I am out of network for Cigna and Kaiser PPO and HMO. I do not accept any Medicaid or Medicare plans.

What brings you to therapy at this point in particular?

What are you hoping to get out of your work with me? What will happen as a result of our successful work together?

Have you been in therapy before? If so, how long?

What has been the most helpful insight, tools or skills you have acquired from the therapy you have received?

Have you received a prior diagnosis at some point in your life? If so, what was your diagnosis?

Have you ever attempted suicide? If so, when?

Describe your relationship with your mother in 3 adjectives

Describe your relationship with your father in 3 adjectives

Describe your social life and what you do for fun or relaxation

What positive qualities do you possess or what do you like most about yourself and want me to know about?

Are you interested in walking sessions?

Yes

No

I understand that data submission through this form is HIPAA compliant

Thanks for submitting! I will review your responses and get back to you as soon as possible.

Individual Therapy

Couples Therapy

I understand that I cannot use insurance for this service and it is cash payment only

Names and ages of family members

Phone Number

Email

What brings your family to therapy at this particular time?

What are you hoping to get out of this experience?

Are any of the family members currently in therapy?

Has anyone attempted suicide?

Have any parents or siblings died?

Whose idea was it to pursue family therapy?

Was there a prompting event that led someone to make this call? Why seek help now?

What are your greatest strengths as a family?

Name the top three concerns you have in your family.

Make at least one suggestion you, and each member of the family, could personally do to improve family relationships.

I understand that data submission through this form is HIPPA compliant

Thanks for submitting! I will review your responses and get back to you as soon as possible.

Relational Family Therapy

Together we will allow the natural process of healing to occur

Schedule Your First Appointment