Helpful Forms

If you are a new adult client, please print and complete the following forms and bring them to your first appointment:

If your adolescent or dependent is a new client, please print and complete the following forms and bring them to your first appointment:  

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:

Note: To download Adobe Acrobat Reader for free, click here.

LOCATION

Availability

Primary

Monday:

By Appointment Only

Tuesday:

By Appointment Only

Wednesday:

By Appointment Only

Thursday:

By Appointment Only

Friday:

Closed

Saturday:

Closed

Sunday:

Closed

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Phone 419-782-2800, Fax 419-758-3677, [email protected]