Helpful Forms


IMAG0322Please print and fill out the forms below. The information you provide will help me get to know you and your child and develop an appropriate treatment plan.


All clients fill out the following forms:

registration form

service agreement/ informed consent

intake assessment form (for children)

intake assessment form (for adults)

hypnotherapy intake questionnaire (for adults)


If you plan to use OUT of NETWORK insurance please fill out this form so I can submit insurance claims on your behalf:

authorization for treatment and payment of medical bills

Bring the forms to your first appointment. I look forward to getting to know you and helping in any way I can!