Forms

Please Print, Complete and Bring these for our initial session

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.