Forms

If you’d like to review my consent forms please click on the form below. Please note that if you choose to engage in therapy services, you will be asked to complete these forms electronically through my system once you are scheduled. You are not required to print these documents. They are listed here simply for informational use only.

Informed Consent Adult
HIPPA
Good Faith Estimate - No Surprises Act
Election to Self Pay

Online License Verification - Ohio Counselor, Social Work, Marriage and Family Therapist Board: https://cswmft.ohio.gov/Online-License-Verification