Client Data Form: All adult clients should complete this form.  Print it out and bring the completed form to your first session.  Download

HIPPA:  The Health Insurance Portability and Accountability Act (HIPAA) is a federal mandate for privacy issues that cover certain health services. Clients over age 18 and parents of adolescent clients are advised to read this form and sign the acknowledgement of receipt prior to their first appointment. You should also print out a copy of this form for your records.  Download

LiveWell Policy Letter:  Adult clients and parents of adolescent client’s should carefully read and sign this document.  Print it out and bring the completed form to your first session.  You should also print a copy of this form for your records.  Download

Credit Card Charge Form: For your convenience, I accept payment by Visa or Mastercard.  This form allows me to charge the session fee (including fees for no-shows and late cancellations) to the credit card designated on this form. Please print out this form, complete it, and bring it to the initial appointment. This information will be stored securely in your clinical file and may be updated upon request at any time.  Download

Child/Adolescent Data Form and Consent for Treatment: Client’s under 18 should have this form completed and signed by a parent or legal guardian.  Download

Privacy Information for Adolescents: If you are a client under age 18, please print out this form, read it carefully, sign it, and bring it to your first appointment. You should also keep an additional copy for your records. Your parent or guardian should complete the Child/Adolescent Data and Consent form above and bring it to the first appointment.  Download

LiveWell Policy Letter:  Adult clients and parents of adolescent client’s should carefully read and sign this document.  Print it out and bring the completed form to your first session.  You should also print a copy of this form for your records.  Download

HIPPA:  The Health Insurance Portability and Accountability Act (HIPAA) is a federal mandate for privacy issues that cover certain health services. Clients over age 18 and parents of adolescent clients are advised to read this form and sign the acknowledgement of receipt prior to their first appointment. You should also print out a copy of this form for your records.  Download

Credit Card Charge Form: For your convenience, I accept payment by Visa or Mastercard.  This form allows me to charge the session fee (including fees for no-shows and late cancellations) to the credit card designated on this form. Please print out this form, complete it, and bring it to the initial appointment. This information will be stored securely in your clinical file and may be updated upon request at any time.  Download