Register

Registration is only required if you do not have a username. Please check your spam & junk mail folders to ensure you have not already received an email with a username and password. If you already have a username log in here

Each account must have a unique email address associated with it. Please contact us if you need multiple accounts with the same email address (i.e. related family members).

Client Type

Client Information

/ Middle Initial

( optional )
 

( MM-DD-YYYY )







( for Text Message Reminders )

Bill To Contact

/ Middle Initial







Log in Details

( If client is a minor, the legal guardian must enter their email address below. )



Between 8 and 40 letters and numbers

Challenge Questions

( These will be used to retrieve your password. Answers must be between 4 and 30 characters, cannot contain any spaces. )




( If you feel you must write down your questions in order to remember them, make sure to keep it in a safe place. )

Terms and Policy

Informed Consent Form
The Informed Consent Form allows you to review my history and understand how we might work while on this journey.
( Type Full Name )
Intake Form
Please complete as much of the Initial Intake Form as you are able before our first session.
( Type Full Name )
Payment terms
Currently, we do not accept insurance plans. We do however, provide you with a receipt for services provided. This receipt will be acceptable for you to submit to your insurance company for allowable repayment as within your insurance coverage.

Payment is required and expected when services are rendered.

Full session fee is charged for appointments not cancelled with a 24 hour notice.
( Type Full Name )