Please complete and email these forms to me before our initial session.
You may convert these PDF's into writeable form if you have software for that, or simply print, complete and scan pages to email.
I will provide my email address when we make our initial appointment.
Forms for all to complete:
New Client Information Form
New Client Consent Form
Forms for those with weight, eating and healthy lifestyle concerns:
Adult and Adolescent Weight-Related Questionnaire
Under 10-years-old Weight-Related Questionnaire
Insurance and Fees
I am an OUT-OF-NETWORK provider for all commercial insurance companies.
My fee is due at the time of each session. We will arrange an electronic payment method (e.g., Zelle, Flex Spending card, or credit card).
As a service to you, I promptly submit electronic claims to your insurance company stating the amount that you have paid for the session and requesting that reimbursements be sent directly to you.
Please contact me for current fees. There is a space to write these in on the consent form.
If you have genuine financial need and no out-of-network insurance, please call to speak with me about the possibility of a discounted fee.
Insurance and Fees
I am an OUT-OF-NETWORK provider for all commercial insurance companies.
My fee is due at the time of each session. We will arrange an electronic payment method (e.g., Zelle, Flex Spending card, or credit card).
As a service to you, I promptly submit electronic claims to your insurance company stating the amount that you have paid for the session and requesting that reimbursements be sent directly to you.
Please contact me for current fees. There is a space to write these in on the consent form.
If you have genuine financial need and no out-of-network insurance, please call to speak with me about the possibility of a discounted fee.