Forms & Information about my Practice
This is some basic information about my practice and some forms you will need to review and sign should we begin treatment. All of these forms can be signed and brought in to the fist session. You can also scan them and email them to the email above.
The best way to communicate with me is via phone or email listed above. Texting is fine after you've signed and reviewed the Informed consent provided below.
The fee for therapy is $175 per 50 minute session. I accept Cash, Check, Zelle (to this email: hopelcsw@protonmail.com) and credit card. I do not accept any insurance. I will provide a statement that you can submit to your insurance.
This document is your personal and contact information.
This is the Informed Consent. For minors both parents/guardians must sign along with the child.
This is the HIPPA Notice of Privacy Practices. It is for your information to have but you do not need to print and sign anything on this document.
This document is one you need to print and sign. It is acknowledging that you received and understood the previous document, The HIPPA Notice of Privacy.
This document is to print and fill only if you want to give me authorization to communicate with someone. An example would be for a psychiatrist or a school personnel. You never have to give me permission to talk to anyone but if you want me to talk to someone you must have this signed and witnessed.