Helpful Forms

If you're a new client, please complete the following forms and bring them to your first therapy session.

If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete this form to authorize release of psychotherapy information:

Note: To download Adobe Acrobat Reader for free, click here.     

 

We are committed to your privacy. Do not include confidential or private information regarding your health condition in this form or any other form found on this website. This form is for general questions or messages to the practitioner.

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We look forward to hearing from you

My Availability

Primary

Monday  

Closed

Tuesday  

10:00 am - 5:00 pm

Wednesday  

10:00 am - 5:00 pm

Thursday  

10:00 am - 5:00 pm

Friday  

10:00 am - 5:00 pm

Saturday  

Closed

Sunday  

Closed

135 N Moon Ave 
Brandon, FL, 33510, US