Practice Forms

bipolar therapy therapist

Wait List Form

Sometimes when my schedule is full, I’m not able to schedule appointments for new patients.  If you’ve spoken with me and learned this is the case and you are interested in waiting for an available appointment, please click on the Wait List Form link, complete the form and submit to me electronically.

Once received, I’ll get back to you when I anticipate being able to work you into my schedule.  DO NOT SUBMIT IF YOU AND I HAVE NOT FIRST COMMUNICATED BY PHONE OR THROUGH EMAIL.

Private Practice Information and Guidelines

This same form is e-mailed to new patients when they initially register through the Patient Portal.  However, you’re welcome to review it if you want to learn more about my practice policies before initiating contact.  

Release of Information

To be used when you want to provide me with permission to communicate with an outside party regarding your treatment.  It can also be used to obtain information from outside providers (current or previous treatment records).  Feel free to print and use this form as needed.