55046 Crape Myrtle Court Ellicott City MD 21042

443-546-4810

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Forms

All Clients

Please print, complete and sign the

CLIENT PACKET

Fee for Service form is for clients who are self-pay and will receive a receipt for services.

Insurance Fee Agreement form is for clients who will be using their insurance for payment.  

Any adjustments to fees and co-pay fees can be addressed when you come to the first appointment.

READ ONLY 

No need to Print - Credentials and Treatment Agreement

Please bring the completed forms to your first visit.  Completing the forms prior to your visit will enable us to have more time to talk during your first visit. You can also choose to complete the forms at the time of your visit.


OTHER FORMS

 

Divorce Coaching/Mediation Clients

Please print out and read the Coaching Contract. You can sign it after you have spoken with me and clarified any concerns you may have.