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Starts With You

Truth in our inward parts... Psalm 51

Woman Being Free


Please read these forms.
You do not need to print these forms.

Please PRINT and complete the following forms and mail them to my office or you can EMAIL them to [email protected]
*Note: Email is not encrypted and therefore not confidential. Please read the Electronic Communication Disclosure above.

If you are a distance client, please sign this form as well as the forms above.

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:


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