Treatment Forms

The Intake Form below is for clients who are considered “Private Pay.” This simply means that a private pay client will not be using insurance and would rather pay out of pocket for convenience.

If you are a potential client who has insurance you would prefer to use, then you do not need to fill this form out and you can access my Headway portal link to establish yourself as a client.

For Hypnotherapy, you can also access the form below as a new client for hypnotherapy. I don’t accept insurance for hypnotherapy.