Please chose one of the following ways to send your completed forms to me:
1) You may fax the forms to me at (860) 635-4556.
2) Email the forms to me at: [email protected]
3) Or send them using traditional mail to:
26 Greenview Terrace
Middletown, CT 06457.
Thank you and I look forward to meeting you.
- Psychotherapy Intake Form
- Insurance Intake Form
- Limits of Confidentiality/Therapy Cancellation Policy
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 .