Forms

NEW CLIENTS -  Kindly complete all the below INTAKE + HIPPA +  MBT Credit Card Authorization Form.

Our practice is mindful that therapy may be of an urgent nature especially towards weekends and holidays. We are available to work with you! We ask that completed forms be in legible handwriting with complete and updated information for methods of payment. If TeleHealth (a remote session) is required please add Telemental Health Informed Consent form to your list.

VERY IMPORTANT - To limit wait times  FORMS MUST BE SCANNED IN ADOBE PDF FORMAT in the correct order and sent to:  [email protected] or Faxed to 561-621-3518. Please bring these forms with you to your first physical appointment.


INTAKE FORMS

* If you would like me to coordinate care with another provider (for example, your psychiatrist, primary care physician, etc.), complete the HIPPA Authorization form to release of psychotherapy information:


PAYMENT AUTHORIZATION FORMS



OTHER FORMS





COACHING

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Mental Health Counseling
Trauma Psychotherapy
Hypnotherapy
EMDR
PTSD/Trauma Therapy

Contact Us

Main Location - (772) 486-4417

2630 SE Willoughby Blvd Suite B2 Stuart, FL 34994

MBT Lake Worth - Nexus Bldg

8461 Lake Worth Road, Suite 126 Lake Worth FL 33467

MBT Palm Bay - (772) 486-4417

1501 Robert J Conlan Blvd NE Suite 200 Palm Bay, FL 32905

MBT Delray - Wild Celery

738 SE 5th Ave Delray, FL 33483