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I am very pleased you have selected me to be your therapist and am sincerely looking forward to assisting you. This document is designed to inform you of the policies and procedures of counseling and therapy. Please read it thoroughly before signing.  Your relationship with me is a collaborative one, so I welcome any questions, comments, or suggestions regarding your care. 
Please complete the online form below. There are 12 sections to complete, so please be thorough in reading the information and submitting your responses. All responses are confidential and securely stored according to HIPAA regulations.
Because of the length of the form, please scroll down within the form to complete all information in each section. You will see the "Next" button at the end of each section. [Once the next page loads, you may need to scroll to the top of the form.] Be sure to hit "Submit" at the end so your responses are recorded.
You will be asked to type your full legal name several times as your signature.  

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